Six studies were included in the review (n=315): 4 RCTs (n=248) and 2 quasi-randomised studies (n=106).
Three studies used an adequate randomisation method and 4 studies reported blinded assessment of the outcome. All studies reported patients lost to follow-up.
The proportion of patients rating their satisfaction as 'excellent' was significantly higher when treated using an early functional protocol compared with standard immobilisation (OR 5.14, 95% CI: 2.61, 10.12, p<0.0001; based on 270 patients in 5 studies). No significant difference was shown between early functional protocols and immobilisation for re-rupture rate (OR 0.62, 95% CI: 0.17, 2.28, p=0.47; based on 310 patients in 6 studies). No statistically significant heterogeneity was detected for either of these meta-analyses (I-squared was zero for both).
There was no difference between early functional protocols and immobilisation for superficial and deep infections (2.6% versus 3.9%; OR 0.75, 95% CI: 0.22, 2.49). Other complications were significantly less common in the early functional protocol groups compared with the immobilisation groups (5.8% versus 13.5%, p=0.01; OR 0.30, 95% CI: 0.12, 0.75).
One study showed that early functional protocols were associated with significantly less calf atrophy and improved planter flexion compared with immobilisation regimens. In contrast, 5 studies reported no significant difference between treatments in calf atrophy or planter flexion strength.
Of the 4 studies that reported on range of motion, one reported significantly greater range of motion in the early functional protocol group (p<0.00001).