The aim of our prospective, randomized, clinical study was to compare two postoperative regimens after Achilles rupture repair and determine whether early functional treatment will give a better result than early immobilization in tension of the musculotendinous unit.
Fifty patients with acute Achilles tendon rupture were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks or Achilles tendon immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks. Full weight bearing was allowed after 3 weeks in both groups. The patients were assessed clinically at 1, 3, 6, 12, and 24 weeks, and the last control visit took place at a mean of 60 (SD 6.4) weeks postoperatively.
The isokinetic calf muscle strength scores were excellent in 56%, good in 32%, fair in 8%, and poor in 4% of the patients in the early motion group at the last control checkup; whereas the scores in the cast group were excellent in 29%, good in 50%, and fair in 21% of the patients. The ankle performance scores were excellent or good in 88%, fair in 4%, and poor in 8% of the patients in the early motion group, whereas the scores in the cast group were excellent or good in 92% and fair in 8% of the patients. At 3 months and at the last control checkup, no significant differences were seen between the two groups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, isokinetic calf muscle strength, or overall outcome. The complications included one rerupture in the early motion group and one deep infection and two reruptures in the cast group. Deep infection and the rerupture in the cast group occurred in the same patient. The outcome of the complications was good in two cases and poor in one.
The isokinetic calf muscle strength results were somewhat better in the early motion group, whereas the other outcome results obtained in the two groups of patients were very similar. We recommend early functional postoperative treatment after Achilles rupture repair for athletes and well-motivated patients and for less-motivated patients and nonathletes.
"Histological studies have shown better collagen formation after mechanical loading (Jarvinen et al., 1997; Kannus et al., 1997; Rantanen et al., 1999; Kjaer et al., 2005). Clinical studies have also shown improved results of early functional treatment after an Achilles tendon rupture (Kangas et al., 2003; Maffulli et al., 2003; Costa et al., 2006; Nilsson-Helander et al., 2010; Willits et al., 2010). However, further studies are needed to evaluate if the degree of weight-bearing and loading of the tendon is affected by kinesiophobia. "
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the short-term recovery of function after an acute Achilles tendon rupture, measured by a single-legged heel-rise test, with main emphasis on the relation to the patient-reported outcomes and fear of physical activity and movement (kinesiophobia). Eighty-one patients treated surgically or non-surgically with early active rehabilitation after Achilles tendon rupture were included in the study. Patient's ability to perform a single-legged heel-rise, physical activity level, patient-reported symptoms, general health, and kinesiophobia was evaluated 12 weeks after the injury. The heel-rise test showed that 40 out of 81 (49%) patients were unable to perform a single heel-rise 12 weeks after the injury. We found that patients who were able to perform a heel-rise were significantly younger, more often of male gender, reported a lesser degree of symptoms, and also had a higher degree of physical activity at 12 weeks. There was also a significant negative correlation between kinesiophobia and all the patient-reported outcomes and the physical activity level. The heel-rise ability appears to be an important early achievement and reflects the general level of healing, which influences patient-reported outcome and physical activity. Future treatment protocols focusing on regaining strength early after the injury therefore seem to be of great importance. Kinesiophobia needs to be addressed early during the rehabilitation process.
Scandinavian Journal of Medicine and Science in Sports 06/2012; 24(1). DOI:10.1111/j.1600-0838.2012.01497.x · 2.90 Impact Factor
"The gap is filled with fibrous tissue that is never as strong as the original tendon, contributing to a high incidence of rerupture (Webb & Bannister, 1999; Wills et al., 1986). The review studies with a large number of patients show the rerupture rate with conservative treatment of 12% (Webb & Bannister, 1999; Lo et al., 1997) to 13,4% (Cetti et al., 1993) although there could be found reports on the functional conservative treatment with the lower incidence of the rerupture rate (Kangas et al., 2003; McComis et al., 1997; Thermann et al., 1995; Twaddle & Poon, 2007; Willits et al., 2010). "
"A comparison is made between this functional bracing system and a minimally invasive operative repair of acute AT ruptures. Both treatment options used in this comparison allow immediate full weight bearing so none of the patients is denied the purported advantage of a functional after treatment [2,5,21-24]. "
[Show abstract][Hide abstract] ABSTRACT: We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture.
At least 72 patients with acute Achilles tendon rupture will be randomized to minimally invasive surgical repair followed by functional rehabilitation using tape bandage or conservative treatment followed by functional rehabilitation with use of a functional bracing system. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction. Patient follow-up will be 12 month.
By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial.
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