***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 
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    ***EXAMPLES*** 
    Input: BACKGROUND We prospect ively analyzed and compared the functional and clinical results of patients with st and ard open and minimally invasive repair with the Achillon suture system  at mid-term followup . MATERIAL S AND METHODS From February 2004 to May 2007 , 40 consecutive patients were operated for the treatment of acute Achilles tendon rupture with two different methods . None of the cases required adjunctive procedures like plantaris , flexor hallucis longus or gastrocnemius augmentation ( Lindholm , Bosworth ) to allow for acceptable end to end apposition . The patients were divided equally into two groups . In Group 1 , only Krakow end-to-end suturing technique and in Group 2 , Minimal invasive repair with Achillon suture system ( Integra Life Sciences Corporation , Plainsboro , NJ ) was used respectively . The average age of the patients was 40 years . Patients in study groups were followed up at mean of 22.4 ( range , 10 to 48 ) months after surgery . At the end of the followup time , functional outcome scores and complications were evaluated . RESULTS The AOFAS hindfoot clinical outcome scores were 98.7 in Group 1 , 96.8 in Group 2 . Although there was a numerical increase in AOFAS Scores in Group 1 , there was no significant difference . The surgical outcome concerning local tenderness , skin adhesions , scar and tendon thickness was better in Group 2 than in Group 1 with statistical significance . CONCLUSION Although functional outcomes of both treatment groups were the same , minimally invasive repair with the Achillon suture system provided safe , reliable and practical treatment with low risk of complications in the treatment of acute Achilles tendon ruptures In a prospect i ve , r and omised , multicentre study , 112 patients ( 99 men and 13 women , aged between 21 and 63 years ) with acute , complete rupture of tendo Achillis were allocated either to surgical treatment followed by early functional rehabilitation , using a brace , or to non-surgical treatment , with plaster splintage for eight weeks . The period of follow-up was for two years . Evaluation was undertaken by independent observers and comprised interviews , clinical measurements , isokinetic muscle performance tests , heel-raise tests and an overall outcome score . The rate of rerupture was 20.8 % after non-surgical and 1.7 % after surgical treatment ( p < 0.001 ) . Surgical and non-surgical treatment produced equally good functional results if complications were avoided . However , the rate of rerupture after non-surgical treatment was unacceptably high BACKGROUND The optimal rehabilitation protocol after surgical repair of an Achilles tendon rupture has not been well defined . The objective of this r and omized study was to compare the effect of early weight-bearing with that of non-weight-bearing on early postoperative recovery following repair of an acutely ruptured Achilles tendon . METHODS Between October 2003 and May 2006 , 110 patients with a surgically repaired Achilles tendon rupture were enrolled from one of two major trauma-care tertiary hospitals . All patients were non-weight-bearing for the first two weeks postoperatively . At the two-week postoperative visit , patients were r and omized to either weight-bearing or non-weight-bearing for an additional four weeks . Compliance was measured with a pressure sensor in the fixed-hinge ankle-foot orthosis given to each patient . Follow-up assessment s were performed at six weeks , three months , and six months postoperatively . The primary outcome was health-related quality of life assessed with use of the R AND 36-Item Health Survey ( R AND -36 ) . Secondary outcomes were activity level , calf strength , ankle range of motion , return to sports and work , and complications . RESULTS Ninety-eight patients ( 89 % ) completed the six-month follow-up . At six weeks , the weight-bearing group had significantly better scores than the non-weight-bearing group in the R AND -36 domains of physical functioning , social functioning , role-emotional , and vitality scores ( p < 0.05 ) . Patients in the weight-bearing group also reported fewer limitations of daily activities at six weeks postoperatively ( p < 0.001 ) . At six months , no significant differences between the groups were seen in any outcome , although both groups had poor endurance of the calf musculature . No rerupture occurred in either group . CONCLUSIONS Early weight-bearing after surgical repair of an acute Achilles tendon rupture improves health-related quality of life in the early postoperative period and has no detrimental effect on recovery We performed two independent , r and omised , controlled trials in order to assess the potential benefits of immediate weight-bearing mobilisation after rupture of the tendo Achillis . The first trial , on operatively-treated patients showed an improved functional outcome for patients mobilised fully weight-bearing after surgical repair . Two cases of re-rupture in the treatment group suggested that careful patient selection is required as patients need to follow a structured rehabilitation regimen . The second trial , on conservatively-treated patients , provided no evidence of a functional benefit from immediate weight-bearing mobilisation . However , the practical advantages of immediate weight-bearing did not predispose the patients to a higher complication rate . In particular , there was no evidence of tendon lengthening or a higher re-rupture rate . We would advocate immediate weight-bearing mobilisation for the rehabilitation of all patients with rupture of the tendo Achillis 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 Introduction There is a trend towards surgical treatment of acute ruptured Achilles tendon . While classical open surgical procedures have been shown to restore good functional capacity , they are potentially associated with significant complications like wound infection and paresthesia . Modern mini-invasive surgical techniques significantly reduce these complications and are also associated with good functional results so that they can be considered as the surgical treatment of choice . Nevertheless , there is still a need for conservative alternative and recent studies report good results with conservative treatment in rigid casts or braces . Patients / method We report the use of a dynamic ankle brace in the conservative treatment of Achilles tendon rupture in a prospect i ve non-r and omised study of 57 consecutive patients . Patients were evaluated at an average follow-up time of 5 years using the modified Leppilahti Ankle Score , and the first 30 patients additionally underwent a clinical examination and muscular testing with a Cybex isokinetic dynamometer at 6 and 12 months . Results We found good and excellent results in most cases . We observed five complete re-ruptures , almost exclusively in case of poor patient ’s compliance , two partial re-ruptures and one deep venous thrombosis complicated by pulmonary embolism . Conclusion Although prospect i ve comparison with other modern treatment options is still required , the functional outcome after early ankle mobilisation in a dynamic cast is good enough to ethically propose this method as an alternative to surgical treatment We prospect ively analyzed the functional and clinical results of patients who underwent a single end-to-end suture and an augmented tendon repair with plantaris tendon at middle-term follow-up . From January 2003 to May 2005 , 30 consecutive patients were operated on for the treatment of acute Achilles ' tendon rupture by means of 2 different methods . No cases required adjunctive procedures to allow for acceptable end-to-end apposition . All ruptures were acute and repairable . The patients were divided into 2 groups . In group 1 , augmentation with plantaris tendon was performed in addition to the Krakow end-to-end suturing technique in 16 patients , and in group 2 , only the Krakow end-to-end suturing technique was used in 14 patients . The average age of the patients was 40.6 years . Patients in the study groups were followed up at a mean of 17.8 months after surgery . At the end of the follow-up , functional and subjective outcome scores were evaluated . The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores were 96.7 in group 1 and 98.8 in group 2 . Although there was a numerical increase in group 2 , no significant difference was determined between the 2 study groups statistically . The surgical outcome concerning local tenderness , skin adhesion scar , and tendon thickness was better in group 2 than in group 1 without a statistical significance . Although functional outcomes of both treatment groups were the same , the end-to-end suturing technique provided a safer and more reliable treatment with a low risk of complications in the treatment of acute Achilles ' tendon ruptures compared with the plantaris tendon augmentation technique 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 Patients in group 1 attended fewer outpatient visits , completely discarded their crutches at an average of 2.5 weeks , and more were satisfied with the results of surgery . At ultrasonography , the average thickness of the repaired tendon was 12.1 mm , with no difference in the thickness of the ruptured tendon regardless of postoperative management . There was no significant difference in isometric strength between the two groups . Conclusions Early weightbearing with the ankle planti grade is not detrimental to the outcome of repair after acute rupture of the Achilles tendon and shortens the time needed for rehabilitation . However , strength deficit and muscle atrophy are not prevented A combined open and percutaneous operative technique has been devised for repair of tendo Achillis . This minimises postoperative scarring . We compared 
    Output:
    
The two moderate-strength recommendations include the suggestions for early postoperative protective weight bearing and for the use of protective devices that allow for postoperative mobilization