achilles tendon rupture accelerated rehab protocol achilles tendon rupture accelerated rehab protocol

Low level calf plyometric exercises (fast CRs, tip toe Bethesda, MD 20894, Web Policies Hydrotherapy may begin if wound healing is adequate. (10% body 2010 Dec 1; 92(17): 276-75. . Frontal and transverse plane agility drills (progress from low velocity to high, then gradually add in sagittal plane drills). Patient Information > Achilles Tendon Ruptures - BOFAS Cardiovascular upper extremity circuit training. Sport/work-specific balance and proprioceptive drills. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Partial <> Epub 2017 Jan 17. Squat and lunge to 70 degrees knee flexion without weight shift. It is important to evaluate whether early functional weight-bearing . Late Achilles Tendon Rupture Repair Rehab - Physiotutors Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. Achilles Tendon Rupture : Wheeless' Textbook of Orthopaedics 2022 Jul 29;12(8):1824. doi: 10.3390/diagnostics12081824. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. With!weighted!resisted . -, Am J Sports Med. 2020-2023 Mr Daniel Goldbloom | Privacy Policy | Disclaimer | Website design: Berwick - St John of God Consulting Suites. 2,3 Controversy still surrounds what the optimal treatment for achilles tendon ruptures is. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. Begin standing calf stretch at 5 weeks (knee flexed and extended) Continue eversion, inversion and plantar flexion isometrics with resistance bands. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Study Selection Criteria Randomized . The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair. Weak . Design Scoping review. It arises near the middle of the calf and rotates approximately 90 degrees laterally during its course to insert on the posterior aspect of the calcaneal tuberosity [ 1, 2 ]. The "2-2-2" Early Mobilization Protocol in Achilles Tendon Rupture: A x\n#}!{B^pq8h*S=rz YTWu]N]zGo?Sz$ByhTTu_[UtzrVZO7'. Please enable it to take advantage of the complete set of features! endstream endobj startxref It is found at the back of the lower leg, just above the heel bone. Acute Achilles Tendon Rupture Repair Rehab | Early Rehab Exercises Epub 2015 Sep 26. Bethesda, MD 20894, Web Policies Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician. HHS Vulnerability Disclosure, Help FOIA endobj Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. Achilles tendon repair - Physiopedia 2022 Jul 25;2022:9722458. doi: 10.1155/2022/9722458. Cardiovascular: stationary bike, StairMaster, swimming. J Bone Joint Surg Am 2010; 92: 2767 - 75. ?h{vV4ECHD+A?E_Q-9U1DJY;p9 I* XX%|EjbwJH(g0Nf5.I ;v$c7H(d a_2d6QN&m etc until cleared by Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Everything went well, had the staples removed yesterday. One study allowed early mobilization leading to excellent subjective and objective results. Moderate load close/open chain calf strengthening to York (UK): Centre for Reviews and Dissemination (UK); 1995-. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment . It helps you walk, run, and jump. A potentially more accelerated rehabilitation and return to activity; Tendon healing with optimal end to end re-attachment, hence restoring Calf muscle-Achilles anatomy with minimal scar tissue bridging. cJ%]lKSfd9\{5D y} Ua~0i}::1Qq){)+"0xpOp bd%\`3 G{$u~` mlEt$/yf;'ds;Z1y4@$ Xr Mastering proprioceptive control in wearing normal footwear. <> PMC We performed a systematic literature search in Medline, Embase and Cochrane library. HHS Vulnerability Disclosure, Help 2 0 obj PDF Rehabilitation Guidelines: Post Achilles Tendon Reconstruction Active ROM between 15 degrees of dorsiflexion and 50 degrees of plantarflexion. 2011 Dec;17(4):211-7 Rerupture after Achilles repair is reported at about 2-12%, with no statistical difference reported between open, percutaneous, augmented, or closed treatment methods [1-4, 7, 9, 16].Open rerupture is an exceedingly rare complication and has only been described a handful of times [17-19].This report is the first case that we are aware of described in the literature of an . <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 594.96 842.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Can begin upper limb sports specific training eg. stream 2016 Jun;24(6):1852-9. doi: 10.1007/s00167-014-3180-5. Active ankle eversion/inversion. Squat to 30 degrees knee flexion without weight shift. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. If you have a concern, please consult with Dr. Roe. 4 0 obj Rehabilitation phases after an Achilles tendon rupture The rehabilitation can be divided into four phases (1): The decision when a patient should proceed from one phase to the next is proposed to be based on both the recovery of the patient and the time since the injury. health, rehab compliance and injury severity, our team has established time frames, precautions and progression criteria that help ensure a safe return to sport. This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). Treatment of acute Achilles tendon rupture - a multicentre, non Must be a complete, mid-substance Achilles tendon rupture & not a tendon avulsion from the calcaneus or gastroc/soleus. Bookshelf Discussion. Introduction Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. Goals: Achilles Tendon Repair Rehabilitation Protocol, North Fork Orthopaedic and Sports Medicine, Lower Extremity Fracture Care Post-Op Instructions. Low velocity and partial ROM for functional movements (squat, step back, lunges). endobj 2021 May 21;36(4):e360407. Achilles Tendinopathy Treatment & Rehab Protocol - Dublin Sports Injury : MOFL?Wo(H&dxl. This acute (sudden) injury occurs when the tendon stretches to its breaking point. eCollection 2021. The acute rupture of the Achilles tendon is a protracted injury. Orthop J Sports Med. Y!_x"o7/_"H4IE(:}/1 1,2 These reviews and other systematic reviews consistently show a slightly lower incidence of re-rupture with operative treatment, which is . Four trials compared early ankle mobilization to immobilization. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Surgery is only the beginning of a long rehabilitation period. Results: 2 0 obj 1 0 obj Functional Rehabilitation for Nonsurgical Treatment of Acute Achilles <>>> 2014 2. Zhang Z, Li Y, Zhang T, Shi M, Song X, Yang S, Liu H, Zhang M, Cui Q, Li Z. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Lightsey HM, Noback PC, Caldwell JE, Trofa DP, Greisberg JK, Vosseller JT. PDF Non-Operative Treatment of Achilles Tendon Ruptures Phase 1 Maximum It connects the muscles of your calf to your heel. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? The acute rupture of the Achilles tendon is a protracted injury. OJSM 2016 2. Hi folks, I am in week three post full Achilles rupture repair surgery. The Achilles tendon gives your leg strength to walk, run and jump. Pull your toes upwards to stretch the Achilles tendon. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? Unauthorized use of these marks is strictly prohibited. An Achilles tendon rupture is a full or partial tear of the Achilles tendon. Front Cell Dev Biol. government site. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. endobj 3 0 obj Achilles Tendon Repair Rehab Protocol & Recovery Time Frame <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1990 Mar;18(2):188-95. Post-op weeks 4-6: If the pt can reach neutral PF/DF comfortably, then neutral boot with small heel lifts, sleep in boot, WBAT (based on pain, swelling and wound) with crutches and boot, active DF to neutral. Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. knee strengthening as To correct these problems, a physical therapist may show you exercises or use hands-on techniques to ease the tension. % nb^t~luNS zRBR}mHbKz!MKCZ?/ibO'"qwDG&lQz=>4 QG`7]qvZ;{t;-rq@ .iij1QB\:Lw;hxAMOPNw(v9`K-{ig@@HymirxF> 3 0 obj Return to the original sport at only 3 months after an Achilles tendon rupture by a combination of intra-tissue injection of freeze-dried platelet-derived factor concentrate and excessively early rehabilitation after operative treatment in a male basketball player: A case report. An insight is given into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP to give an insight into the course of recovery after ATRs. 1 This is called "eccentric loading." If you have Achilles tendonitis, walking and running can be painful. weight Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. He was able to ambulate without assistive devices at the 5-week follow-up examination. Knee Surg Sports Traumatol Arthrosc. It is recommended that clinicians collaborate PDF Non-Operative Achilles Rupture Rehabilitation Guideline - Sanford Health Surgery is only the beginning of a long rehabilitation period. IRh3J@+ZR*RNE+Ni$Gg3) x):+!#$SEL*u:Jd4r Good control and no pain with sport/work-specific movements, including the impact. postop. %PDF-1.5 % 4 However, this . Functional movements (squats, step backs, lunges). Epub 2014 Jul 24. management of Achilles tendon ruptures. Mosconi M, Pasta G, Annunziata S, Guerrieri V, Ghiara M, Perelli S, Torriani C, Grassi FA, Jannelli E. Diagnostics (Basel). There is increasing evidence, summarized in systematic reviews, that one can successfully use a non-operative treatment protocol to manage patients who suffer an acute rupture of the Achilles tendon. 3. Arch Orthop Trauma Surg. Muscle strength and balance. leg jumps, skipping). Light concentric and eccentric calf raises with heel lift and progression to resisted ankle doi: 10.1590/ACB360407. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The acute rupture of the Achilles tendon is a protracted injury. 2011 Apr;39(4):820-4 Accessibility Post-activity soreness should resolve within 24 hours. Post-op weeks 2-3: boot at 20 degrees, sleep in boot, TTWB with crutches, no active DF. Achilles Rupture - Physiopedia Static balance exercises (begin in two-foot stance, then two-foot stance on balance board and gradually progress to single-leg stance). 2007 Nov 6;8:108. doi: 10.1186/1471-2474-8-108. Federal government websites often end in .gov or .mil. Accelerated rehabilitation following Achilles tendon repair after acute Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Very gently at first and gradually build up . Passive dorsiflexion both with knee in extension and flexed to 35 - 400 until gentle stretch on achilles. <> official website and that any information you provide is encrypted Achilles Tendon rupture: Post Surgery actions and recovery protocols The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. Westin et al. Careers. Four trials compared early ankle mobilization to immobilization. One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. J Bone Joint Surg Am. Foot Ankle Spec. Operative Versus Nonoperative Treatment of Acute Achilles Tendon Tendon is a specialized tissue mainly composed of collagen extracellular matrix (ECM), transmitting forces from muscle to bone [1].Tendon injury accounts for a large proportion of musculoskeletal system disorders and poses a substantial burden on human health [2].Therapeutic interventions including surgery, drug, physical therapy and rehabilitation are used for tendon repair [3]. Procedure: Conservative Management of Tendo-Achilles Rupture - Accelerated 8-week protocol Indications for Procedure: Tendo-Achilles Rupture Expected Length of Stay: n/a Surgeons: All orthopaedic trauma surgeons Scope of Practice These guidelines are designed to guide physiotherapists when treating patients following conservative management . Achilles Tendon Rupture - Foot & Ankle - Orthobullets Begin physio guided active range of motion ankle exercises from week 3-4. Achilles tendinopathy can be described as an insertional or mid-portion, the difference . Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. Acta Cir Bras. Higher level proprioception Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Purpose: Objectives To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. 12 weeks with supervision (double /n%^xij_2]!J] n >!UGld FOIA 3. No study found an increased rerupture rate for the more progressive treatment. After the second postoperative week controlled ankle mobilization by free. No wound complications. Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol, Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet], Centre for Reviews and Dissemination (UK). Everything went well, had the staples removed yesterday. 8600 Rockville Pike Accessibility Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon. . stream Touch weight The Achilles tendon is a strong, fibrous cord in the lower leg. For best outcomes, the Achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. 2018 Mar;26(3):846-853. doi: 10.1007/s00167-015-3795-1. Results: Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. <>/Metadata 1559 0 R/ViewerPreferences 1560 0 R>> Achilles Tendon Rupture: What Is It, Symptoms & Treatment Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. Ruptures of the tendo achillis. Five trials compared full to non weight bearing, all applying immobilization in equinus. <>>> Resistance Exercises in Early Functional Rehabilitation for Achilles Begin gait and ankle proprioception retraining. endobj There is still no consensus about the post-operative treatment after minimal invasive repair. Active stretching. Open Achilles Tendon Rerupture: A Case Report and Review of - Hindawi ACHILLES TENDON RUPTURE Accelerated Functional Rehabilitation Protocol 0 - 2 WEEKS Aircast boot with 2 cm heel lift NWB with crutches 2 - 6 WEEKS Aircast boot with 2 cm heel lift Protected weight-bearing with crutches as required Active plantar and dorsi flexion to neutral, inversion /eversion below neutral Hepatocyte Growth Factor-Induced Tendon Stem Cell Conditioned Medium Promotes Healing of Injured Achilles Tendon. Blood Flow Restriction Training After Achilles Tendon Rupture 24 staples. Unauthorized use of these marks is strictly prohibited. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. Multi-plane proprioceptive exercises single-leg stance. Federal government websites often end in .gov or .mil. Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW. Injury to the Achilles tendon causes pain along the back of your leg near the heel. Continue hip and 179 0 obj <> endobj Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. sharing sensitive information, make sure youre on a federal Epub 2020 Dec 17. q{b7\68wbZaX?MN3 ,iFaI!_>bT=BL~>k9Z'V>Y'Zo5M:Bt>Oby^|pRh/0UhclP"t~** 0! endobj Normalize gait on all surfaces without boot or heel lift. The Achilles tendon, which is about 12-15 cm long and comprises both the gastrocnemius and the soleus tendons, is the thickest, strongest and largest tendon in the human body. The exercises stretch your Achilles tendon in ways that help it handle forces and stress better. MRI studies may be indicated for surgical management of chronic injuries. The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. Introduction. Slowly wean from boot. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy Sport Medicine. Early functional rehabilitation protocol for Achilles tendon rupture improved patient satisfaction, compared with standard immobilisation regimens, with reductions in minor complications and no difference in re-rupture rates. TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol Time Frame Activity 0-2 weeks Posterior slab/splint; non-weight-bearing with crutches: immed. It is rare to have this procedure immediately after going to the emergency room for an injury. Various treatment methods are used for acute and chronic rupture. Multiple surgical and nonsurgical approaches to treatment exist, 28 and the superiority of one over the other remains controversial and depends on patient factors and preferences. Diagnosis can be made clinically with weakness of plantarflexion with a positive Thompson's test. x=ko8?hsQH{i~Pb%1{$[lt@Y$ujzS^/W8X:RNj]_/U9..7z" %%EOF weight) The site is secure. Injury2014;45(11):1782-1790. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. endobj Active ROM between 5 degrees of DF and 40 degrees of PF. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Weight-bearing: Touchdown weight-bearing (TDWB) with crutches After the Achilles tendon rupture repaired , patients were randomly divided into 2 groups, and the rehabilitation protocol was traditional rehabilitation protocol and accelerated rehabilitation protocol under ultrasonic monitoring , respectively, to study the difference in efficacy between the groups. eCollection 2022. Bookshelf The Efficacy of Different Rehabilitation Protocols After Achilles The Thompson Test should be applied in all suspected cases Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury The clinical outcomes are similar regardless of the surgical treatment, but an accelerated rehabilitation program should be accompanied by good results. Methods: bearing transitioning towards full weightbearing. Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. initially official website and that any information you provide is encrypted Hydrotherapy In revision cases or when the tendon was damaged before the rupture, the tendon may need to be reconstructed using a graft from another tendon in your body. #WDA Closed chain weight bearing quads, hamstrings, glutes, calf strengthening with physio guidance. Achilles Tendon Surgery: Preparation and Recovery - Verywell Health KoreaMed Synapse Post-op weeks 3-4: boot at 10 degrees, sleep in boot, TTWB with crutches. Goals: Protection of repair and achieve active dorsiflexion (DF) to neutral. sharing sensitive information, make sure youre on a federal **No hopping, Epub 2014 Jul 7. Arch Orthop Trauma Surg. It's the largest tendon in your body. Good control and no pain with functional movements, including step-up/down, squats and lunges. 1.Introduction. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Effect of Transdermal Fentanyl Patch Combined with Enhanced Recovery after Surgery on the Curative Effect and Analgesic Effect of Liver Cancer. Biomed Res Int. Methods: Seven studies were included. Place heel raises (1-2cm) in shoes to take some of the pressure off the Achilles tendon. Treatments are chosen based on the size of the tendon defect. Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. jumping, running. movements (not past plantar grade). Five trials compared full to non weight bearing, all applying immobilization in equinus. Disclaimer. 2003 Jun;54(6):1171-80; discussion 1180-1. doi: 10.1097/01.TA.0000047945.20863.A2. Review Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence . As a result, an effective rehabilitation protocol for Achilles tendon rupture appears to be more important than the surgical treatment method itself. endstream endobj 180 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 177 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 181 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 182 0 obj <>stream Avoid overstressing the repair (avoid large movements up and down, forceful PF while in a dorsiflexed position, aggressive passive ROM, and impact activities). PoT"u+: PDF Standard of Care: Achilles Tendinopathy - Brigham and Women's Hospital Detractors of conservative treatment argue that this option leads to a greater risk of a re-rupture when compared to surgical treatment. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Ruptured Achilles: How to Recover From Achilles Tendon Injury - WebMD The .gov means its official. Continue resisted inversion and eversion through range, Double leg stance out of boot; single leg stand in boot progressing to out of boot as balance improves. The Accelerated Rehabilitation Program lasts for 12 weeks and is supervised by your Physiotherapist. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Achilles Tendon Repair Surgery | Johns Hopkins Medicine Copyright 2014 Elsevier Ltd. All rights reserved. Clinical, Ultrasonographic, and Elastographic Comparison. Splint/Boot: Locked 20-30 degree plantarflexion for two weeks We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Achilles tendon repair is performed after injury occurs to the Achilles tendon. NCI CPTC Antibody Characterization Program, Foot Ankle Surg. Rehabilitation following Achilles tendon repair is vital in regaining motion, strength and function. Moderate load plyometrics at Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. 2014 Nov;45(11):1782-90 CAMBOOT with 10mm heel lift or VACOPED at (1) with flat sole for 4th week View a complete list of our locations and hours. high load ankle, knee, hip Careers. II. Surgery is only the beginning of a long rehabilitation period. endobj A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Wr5)Z nK!e*~[~[)$WoU]sMHUoUbmJ9yOJ}` Normalize gait on level surfaces without boot or heel lift. Calf muscle rehabilitation post Achilles tendon rupture Emerg Med Int. MeSH 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. 3{pn04,NMi"]C@C!r-\8yJY cMylwJ nOVn:K"ldCsseC! %PDF-1.7 Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. <> Seven studies were included. Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 5 0 R/Group<>/Tabs/S/StructParents 1>> PDF ACHILLES RUPTURE: NONOPERATIVE PROTOCOL - South Bend Orthopaedic Associates Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. The achilles tendon accounts for 20% of all large tendon injuries 1 with an estimated incidence ranging from 11 to 37 per 100,000. Operative versus non-operative treatment of acute Achilles tendon ruptures: a multi-center randomized trial using accelerated functional rehabilitation.