Rehabilitation protocols after ankle surgeries: A narrative literature review

Abstract

Introduction: This narrative review explores the findings of randomized controlled trials (RCTs) in terms of timing and the components of ankle rehabilitation. Method: We reviewed RCTs since 1986 and categorized them by the timing and the components of the intervention. The timing of intervention was classified as immediate, early and delayed ankle rehabilitation. The component of intervention was categorized based on whether ankle motion or weight bearing was assessed individually against “no intervention” or as an additional component compared to the control arm. Results: A total of 20 RCTs were included. Four evaluated immediate/early ankle motion against immobilization and five assessed the efficacy of immediate/early weight bearing versus delayed weight bearing. Six RCTs assessed the additional benefit of immediate/early ankle motion programs on weight bearing and four evaluated the additional benefit of immediate/early weight bearing on ankle motion programs. One RCT compared combined “early ankle motion and early weight bearing” with delayed rehabilitation. Conclusion: This review suggests that both ankle motion and weight bearing lead to improved function and faster return to work compared with no intervention. Adding ankle motion to weight bearing programs did not show significant functional benefit, while adding weight bearing to ankle motion programs significantly improved function and lead to earlier return to work. Immediate/early rehabilitation programs appear safe regarding the risk of reduction loss and deep vein thrombosis (DVT) except in syndesmotic fractures. However, they were associated with a higher incidence of superficial wound complications compared with delayed rehabilitation.