Rehabilitation Protocol Post-Operative Tendon Repair

Immediate Post-Operative Phase (0-2 Weeks)

The American Academy of Orthopaedic Surgeons recommends initiating protected weight-bearing within 2 weeks of surgery for lower extremity tendon repairs, as this significantly reduces return-to-activity time during the first 6 months without affecting long-term outcomes 1, 2
A protective device that limits dorsiflexion should be used to prevent excessive strain on the repair, with immobilization in maximum plantar flexion initially for Achilles repairs, transitioning to a walking boot that restricts dorsiflexion 1, 3, 4
Patient compliance is essential, as documented reruptures occur with non-compliance to protective devices and premature unprotected weight-bearing 1, 2

The American Academy of Orthopaedic Surgeons suggests transitioning to active mobilization using a protective device by 2-4 weeks post-operatively, which accelerates functional recovery without compromising tendon integrity or increasing rerupture risk 1, 3
Early mobilization improves knee flexion and extension range of motion without compromising joint laxity, regardless of graft type, with the British Journal of Sports Medicine recommending early active mobilization protocols for superior outcomes 5, 6, 7

Eccentric strengthening exercises should be initiated at 3 weeks using progressive resistance, resulting in greater strength gains, better daily activity levels, and greater muscle hypertrophy compared to delayed initiation at 12 weeks, as recommended by the British Journal of Sports Medicine 5, 6
Open kinetic chain exercises can be added at 4 weeks for lower extremity repairs, starting with seated knee extension from 90° to 45° of flexion, though monitoring for anterior knee pain is necessary 5, 6, 7

By 9 weeks post-repair, patients should be fully weight-bearing without protective devices, actively working on progressive range of motion and structured strengthening, according to the American Academy of Orthopaedic Surgeons 2
Eccentric training protocols demonstrate persistent beneficial effects at 1 year without affecting laxity, pain, or swelling, as reported by the British Journal of Sports Medicine 5, 6

The American Academy of Orthopaedic Surgeons recommends planning for return to sports between 3-6 months post-surgery for surgically treated tendon repairs, with low-impact activities typically beginning around 10-12 weeks 1, 2, 3
Full sports participation is generally safe at 4-6 months depending on sport demands and functional testing, as suggested by the American Academy of Orthopaedic Surgeons 2