***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omised , multicentre study , 112 patients with Achilles tendon rupture ( ATR ) were allocated to surgical treatment  ( n=59 ) , followed by early functional rehabilitation using a brace , and non-surgical treatment ( n=53 ) , i.e. eight weeks of plaster treatment . In this study , the results of the isokinetic muscle strength evaluation are presented for contractions in both the concentric and the eccentric mode , plantar flexion and dorsiflexion , two angular velocities and three different positions of the subject . The heel-raise test for endurance , maximum calf circumference and tendon width were also evaluated . The re-rupture rate was 20.8 % in the non-surgically-treated group and 1.7 % in the surgically-treated group . No significant differences were found between the treatment groups in terms of the isokinetic strength measurements and the endurance test among the patients who did not sustain a re-rupture . If a re-rupture is avoided , both surgical and non-surgical treatment for ATR produce good functional outcome ; however , the muscle function was not restored after two years in either group Ultrasonography and MRI are highly reliable and reproducible methods of determining the separation of a ruptured Achilles tendon and the degree of tendon repair in the course of healing . While MRI is expensive , it can be restricted to research and special indications . In a r and omized trial a operative treatment and a conservative/functional treatment with a newly developed boot were compared in 50 patients ( 22 of whom underwent operative treatment and 28 , conservative treatment ) . In this trial there were no significant differences either in the functional results or in the course of healing . Functional treatment in both groups allowed shorter periods of rehabilitation , and acceptance of the boot was particularly high in all patients Hexcelite(R ) and plaster of Paris below-knee walking casts were compared in a controlled clinical trial , involving 82 patients .  Fewer b and age complications , problems and better comfort was found with Hexcelite compared to plaster of Paris ( P<0.05 ) . If all costs relating to material s , transportation , complications and extra visits due to these , were taken into account , plaster of Paris was found more expensive than Hexcelite ® . Based on the above an increased use of Hexcelite ® is recommended This prospect i ve , r and omized trial compared healing characteristics of the Achilles tendon after surgical and nonsurgical treatment for complete rupture of the Achilles tendon . Fifty-eight patients were examined by ultrasonography after 6 , 12 , and 24 months and by magnetic resonance imaging after 12 months . A st and ardized protocol was used , and the outcome was correlated with clinical findings . Common findings 1 year after the injury were tendon thickening and moderate heterogeneity of the tendon . Peritendinous reactions , edema , and defects were present only in a minority of patients . There were no significant differences between the treatment groups in any of the evaluated parameters apart from the gliding function of the tendon , which was significantly less in the surgically treated group than in the nonsurgically treated group . No correlations were found between the radiological findings and the clinical parameters , such as muscle strength , endurance , and range of motion . We conclude that the roles of ultrasonography and magnetic resonance imaging during the healing process after Achilles tendon rupture are limited , due to a weak correlation with clinical findings The purpose of the study was to examine the recovery of some motor performance aspects of the lower extremity after Achilles tendon ( AT ) rupture repair by early functional postoperative treatment and early postoperative immobilization of the AT in tension in the early phase of recovery . The measured motor performance aspects were reaction time , speed of movement , foot tapping speed and coordination . The study population comprised 30 patients operated on for an acute , complete , closed AT rupture . The surgical technique was Kessler sutures plus one aponeurosis flap in all cases , and postoperatively the subjects were r and omly divided to have immobilization with a plaster cast or an active brace . Measurements were made 12 and 24 weeks after the operation . There were no statistically significant differences in the results between the operated and contralateral nonoperated lower extremities 12 and 24 weeks after the operation in either group . When the results were compared between the plaster cast and active brace groups , no statistically significant differences were seen in reaction times , speed of movement , tapping speed and anterior-posterior coordination on either side , but the lateral coordination value of the operated leg was higher in the plaster cast group than in the active brace group 12 weeks after the operation ( p<0.05 ) . By 24 weeks after the operation , this unique difference had disappeared . It seems that the recovery of the above mentioned motor performance functions of the leg does not depend on whether the leg is in a plaster cast with the AT in tension or in an active brace during the early postoperative period after AT rupture repair . These functions of the operated leg had recovered to the level of the contralateral nonoperated leg by 12 weeks after the operation The object of this study was to compare treatment of ruptured Achilles tendon by operative " end to end " surgery , percutaneous repair , or conservative therapy clinical ly ; a subject of considerable controversy in the literature . These three methods were compared in 73 patients in a r and omized trial between 1994 and 1996 . After 2.5 years ( 11 - 41 months ) , the actual activities were assigned to the Hannover Achilles tendon score and the ability of doing work or sport activities was assessed . After this period , 59.3 % of the patients showed good and excellent results on the Achilles tendon score , with over 79 points ( open surgery 59.1 % , percutaneous 60 % , conservative treatment 58.3 % ) . None of the patients reached the maximum score of 100 points . During the isometric strength tests , the patients with percutaneous repair had a lower weakening of the treated leg ( 8.9 % ) compared to the open-operated ( 12.7 % ) and non-operated patients ( 17.8 % ) . Of the patients who had percutaneous surgery , 88 % rated their treatment as good or excellent ; those who had open surgery 77.3 % , and those with conservative treatment 75 % . The percutaneous group were able to resume work and sport much sooner than the other two groups . Bearing in mind the literature and these results , we have developed an algorithm for treating Achilles tendon rupture to assist decision making in daily routine . In this way , the use of percutaneous Achilles tendon repair can be carried out in most of cases A prospect i ve r and omized controlled trial comparing open and percutaneous repair  of closed ruptured Achilles tendons was performed over a period of 30 months . Sixty-six patients from seven district general hospitals were entered into the study with 33 patients r and omized into each group . A modification of the technique described by Ma and Griffith was used in the percutaneous group and a Kessler suture supplemented with interrupted sutures was used in the open group . Patients were followed up for a minimum of six months . The mean age was 38.5 years ( 26 to 53 years ) . Forty patients were male and 26 female . After the rupturing event but prior to surgery , it was noted that seven patients had paresthesia in the territory of the sural nerve . The mean duration of immobilization was 12.4 weeks ( 10 to 14 ) . The complications in the open group included seven wound infections ( 21 % ) , two adhesions ( 6 % ) and two cases of re-rupture ( 6 % ) . In the percutaneous group there were three cases of wound puckering ( 9 % ) , one re-rupture ( 3 % ) and one case with persistent paresthesia in the sural nerve territory ( 3 % ) . The difference in infective wound complications between the two groups was statistically significant ( Fisher 's exact test P = 0.01 ) . Percutaneous repair is advocated on the basis of the low rate of complications and improved cosmetic appearance BACKGROUND Different regimens of early motion of the ankle  after operative treatment of a ruptured Achilles tendon have been suggested since the late 1980s . However , as far as we know , no controlled studies comparing these regimens with conventional immobilization in a cast have been reported . METHODS In a prospect i ve study , seventy-one patients who had an acute rupture of the Achilles tendon were r and omized to either conventional postoperative management with a cast for eight weeks or early restricted motion of the ankle in a below-the-knee brace for six weeks . The brace was modified with an elastic b and on the posterior surface , in a manner similar to the principle of Kleinert traction . Metal markers were placed in the tendon , and the separation between them was measured on serial radiographs during the first twelve weeks postoperatively . The patients were assessed clinical ly when the cast or brace was removed , at twelve weeks postoperatively , and at a median of sixteen months postoperatively . RESULTS The separation between the markers at twelve weeks postoperatively was nearly identical in the two groups , with a median separation of 11.5 millimeters ( range , zero to thirty-three millimeters ) in the patients managed with early motion of the ankle and nine millimeters ( range , one to forty-one millimeters ) in the patients managed with a cast . The separation was primarily correlated with the initial tautness of the repair ( r[S ] = 0.45 ) . No patient had excessive lengthening of the tendon . The patients managed with early motion had a smaller initial loss in the range of motion , and they returned to work and sports activities sooner than those managed with a cast . Furthermore , there were fewer visible adhesions between the repaired tendon and the skin in the patients managed with early motion , and these patients were subjectively more satisfied with the overall result . The patients in both groups recovered a median of 89 percent of strength of plantar flexion compared with that of the noninjured limb , as measured with an isometric strain-gauge at 15 degrees of dorsiflexion . The heel-rise index was similar for both groups : 0.88 for the patients managed with early motion and 0.89 for those managed with a cast . CONCLUSIONS Early restricted motion appears to shorten the time needed for rehabilitation . There were no complications related to early motion in these patients . However , early unloaded exercises did not prevent muscle atrophy Abstract . Thirty-eight patients ( mean age 49 years ; range 19–91 years ; nine of them over 60 years ; 28 women , 10 men ) suffering from an isolated Weber B fracture with a dislocation of less than 1 mm underwent functional therapy using a pneumatic ankle brace  and were included in a prospect i ve study . The clinical outcome was measured according to the Olerud-Mol and er ankle score . Functional therapy was finished in 34 cases successfully . Twenty-one patients were scored after 17 months on average ( range 8–27 months ) with the Olerud-Mol and er ankle score . A very good result was seen in 18 patients , including 12 with 100 points , a complete remission . The remaining 3 patients showed good results ( 1 had 90 , 2 had 85 ) . However , functional treatment failed in 4 cases due to secondary dislocation . These patients underwent surgery without further complications . The control group , 31 operated patients , did not show as good results . Functional therapy of stable Weber-B ankle fractures appears to be superior to surgery . We were able to avoid surgery in 90 % of our patients and got better results than with patients undergoing open reduction and internal fixation Abstract . The aim of this study was to compare the clinical outcome for patients treated with walking cast immobilization and wrap early mobilization after surgical repair of acute Achilles tendon ruptures . A total of 39 consecutive patients with complete ruptures of the Achilles tendon were identified , treated , and functionally rehabilitated with either a walking cast or a wrap . Because the r and omization was quasi-r and om , chi-square and t-tests were performed to compare the baseline characteristics . A statistically significant difference was present only for the injured side ( p<0.05 ) . Therefore , groups were considered comparable for analysis of outcome . All patients were evaluated at an average follow-up of 6.7 years ( range 5–8 years ) . Functional postoperative treatment with a wrap allowed a significantly shorter hospital stay ( p<0.05 ) as well as a shorter period to return to pre-injury sports level ( p<0.01 ) compared with treatment with a walking cast . According to the modified Rupp score , 91.3 % of patients in the walking cast group had a good or excellent result , as did 93.8 % in the wrap group ( p=0.9 ) . Slight atrophy of the calf muscles was reported in 3 patients in the walking cast group ( 13.0 % ) and in 4 in the wrap group ( 25.0 % ) . One re-rupture was reported in the walking cast group ( 4.3 % ) . Functional treatment after surgical Achilles tendon repair is safe , and there is no increased risk of re-rupture or wound healing problems . Functional treatment with a wrap is preferable to treatment with a walking cast with respect to hospitalization time and return to sports Purpose To study the effects of early weightbearing and ankle mobilization after acute repair of ruptured Achilles tendon . Study Design Comparative longitudinal study . Methods Patients in group 1 were postoperatively immobilized with their ankle in gravity equinus , they were encouraged to bear weight on the operated limb as soon as possible to full weightbearing , and they received a single cast change at 2 weeks , with the ankle accommo date d in an anterior splint in a planti grade position , allowing the ankle to be plantar flexed fully but not dorsiflexed above neutral . Patients in group 2 were immobilized with their ankle in full equinus with a cast change at 2 weeks , when the ankle was immobilized in mid equinus , and at 4 weeks , when the ankle was immobilized in a planti grade position , and they were advised to bear weight . Results 
    Output:
    
REVIEW ERS ' CONCLUSIONS Open operative treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared to non-operative treatment , but produces a significantly higher risk of other complications , including wound infection .
The latter may be reduced by performing surgery percutaneously .
Post-operative splintage in a functional brace appears to reduce hospital stay , time off work and sports , and may lower the overall complication rate