Table 1 Cohort description

Nilsson-Helander et al. [8]

(n = 97)

Clinically verified ATR which was treated within 72 h.

Diabetes mellitus, previous ATR, other lower leg injuries, immunosuppressive therapy and neurovascular diseases.

Seventy-nine patients were treated surgically using the modified Kessler suture technique 8 and 1–0 PDS. The paratenon was carefully repaired and the skin closed with interrupted nylon sutures. Post-operatively, the patients were placed in a below-the-knee cast with the foot in the 30° equinus position.

Fourteen patients were treated immediately after randomisation, with a below-the-knee cast with the foot in the equinus position.

All the patients in both groups were treated with a below-the-knee cast with the foot in the equinus position for 2 weeks, followed by an adjustable angle brace by a physiotherapist for the next 6 weeks. Weightbearing as tolerated was allowed after 6 to 8 weeks.

Olsson et al. [9]

(n = 100)

Clinically verified closed mid-tendon substance rupture treated within 96 h.

Previous ATR, other lower leg injuries, neuromuscular diseases, diabetes mellitus, peripheral vascular disease, immunosuppressive treatment and inability to attend follow-up.

Forty-two patients were operated on using the modified Kessler technique. The tendon was repaired end to end using core suturing with two strong semi-absorbable sutures. No cast was used and the ankle was post-operatively immobilised in a pneumatic walker brace including three heel pads that produce a plantarflexion angle of approximately 22°.

Forty-five patients were treated immediately after randomisation, using the same brace as in the surgical group, including the three heel pads.

Patients were allowed full weightbearing, which was encouraged from the first post-operative day for both groups. Early active rehabilitation started 2 weeks post-operatively and included both range of motion and strength training following a standardised protocol. The surgical group was mobilized in the brace for 6 weeks and the non-surgical group for 8 weeks.

Aufwerber et al. [12] (n = 150)

Clinically verified ATR which was treated within one week.

Ongoing anticoagulation treatment, known kidney failure, heart failure with pitting oedema, thrombophlebitis, thromboembolic event during the previous 3 months, known malignancy, haemophilia, pregnancy, other surgery during the previous month, inability to follow instructions and planned follow-up at another hospital.

One hundred and three patients were operated on surgically using the modified Kessler suture technique with two 1–0 polydioxanone (PDS II) sutures. The paratenon and fascia cruris were then sutured separately using 3–0 Vicryl (Ethicon). After surgery the patients were prospectively randomised into two groups, a full-weight-bearing and non-weight-bearing rehabilitation regime.

Domeij-Arverud et al. [11]

(n = 26)

Clinically verified ATR which was treated within 72 h.

Same as Aufwerber et al. [12]

Twenty-five patients were operated surgically using the same techniques as Valkering et al. [13]

All patients received a below-knee plaster cast with the ankle in 30° equinus and were non-weight-bearing with crutches during the first 2 weeks.

After surgery the patients were prospectively randomised into two groups, both groups non-weight-bearing, but the intervention group received adjuvant foot intermittent pneumatic compression.

Domeij-Arverud et al. [10]

(n = 150)

Clinically verified ATR which was treated within 96 h.

Same as Aufwerber et al. [12]

One hundred and nineteen patients were operated surgically using the same techniques as Valkering et al. [13]

After surgery the patients were prospectively randomised into two groups both groups non-weight-bearing, but the intervention group received adjuvant calf intermittent pneumatic compression.