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28 What to include during optimal rehabilitation of Achilles tendon ruptures managed non-surgically – a delphi study of world tendon experts

bmjosem · 2026-01-20 · canonical JSON source

2 visible annotations · policy: published · automated confidence ≥ 75.00%

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Introduction Achilles tendon rupture (ATR) rehabilitation lacks consensus, causing large variations in management and inferior clinical outcomes. This study gathered expert opinion to identify essential components of optimal non-surgical ATR rehabilitation.Materials and Methods A Delphi study of world tendon experts who had ≥2 publications on ATR as lead/senior author in the past 10 years. These experts then identified clinical experts using snowball sampling. Three Delphi rounds were completed to understand 1) the number and duration of rehabilitation stages 2) the treatments and outcome measures at each stage 3) the essential treatments and outcomes at each stage.Results A total of 31 experts were recruited with 22 (71%) completing all rounds. Experts identified three distinct rehabilitation stages using timeframes 1) Early-Stage Rehabilitation (0 to 8–12 weeks), Mid-Stage Rehabilitation (8–12 to 26 weeks), and Late-Stage Rehabilitation (26 to 52 weeks).Initial immobilisation during early-stage rehabilitation included 2 weeks in a cast or fixed boot, then 2 weeks in a fixed or dynamized boot followed by 4–8 weeks in a fixed or dynamized boot.ATR pathology information, boot/cast immobilisation information and exercise specific guidance were seen as essential educational components. The delivery of this education should be provided verbally during a consultation.Essential treatments, patient reported outcomes and objective outcomes were identified for each rehabilitation stage for an individual returning to sport.Conclusion This is the first study to gather a broad expert opinion on non-surgical ATR rehabilitation. Rehabilitation stages have been established which include essential rehabilitation treatments and outcomes to guide clinical decision making.