Effectiveness of Early Functional Mobilization in Postoperative Rehabilitation Following Acute Achilles Tendon Rupture: A Systematic Review

Abstract

Background. Acute Achilles tendon rupture (AATR) requires effective postoperative rehabilitation. The choice between early functional mobilization (EFM) protocols and traditional immobilization remains controversial in the medical community, mainly because of concerns about excessive elongation of the tendon scar and chronic muscle strength deficits.

Aim. Assessment of the influence of early mobilization on the functional and biomechanical outcomes and quality of life of patients after surgical treatment of acute Achilles tendon rupture.

Materials and methods. In accordance with the PRISMA 2020 guidelines, the PubMed and PEDro electronic databases were searched (during the period May-July 2026). Randomized clinical trials (RCTs) comparing the effectiveness of early activation with immobilization after AATR surgery were included in the review. Three articles were subjected to detailed analysis.

Results. The analysis does not show statistically significant differences in long-term (12-month) functional outcomes (e.g., ATRS, isometric strength) between EFM and immobilization. However, EFM protocols bring measurable short-term benefits (weeks 4-8): faster increase in plantar flexion strength, better plasticity of the musculotendinous junction, and higher patient vitality. Early weight-bearing does not affect excessive tendon elongation - this process progresses for up to 6 months regardless of the method. Complications (e.g., deep vein thrombosis) permanently worsen functional outcomes.

Conclusions. Early mobilization protocols (EFM) are safe, do not intensify tendon elongation, and accelerate initial psychosocial and strength recovery. In the long-term perspective, the effects of both methods become equal. Further objective multicenter studies (using MRI or EMG) are indicated.