No abstract

Context: Pathologic plantar flexion frequently occurs after operative repair of the Achilles tendon (AT) because of immobilization and non-weight bearing in the first weeks of traditional rehabilitation. Novel rehabilitation strategies that apply mobilization and weight bearing have been proposed, but their effects on medial gastrocnemius myotendinous junction displacement (MJD) and isometric plantar-flexion strength (PFS) are unknown.Objective: To compare the effects of 12 weeks of immediate versus traditional rehabilitation on MJD and PFS in patients with percutaneous AT repair and to compare AT rupture scores (ATRSs) during follow-up.Design: Controlled laboratory study. Setting: Human performance laboratory. Patients or Other Participants: A total of 26 amateur soccer players (age ¼ 42.3 6 9.7 years, body mass index ¼ 29.5 6 3.9 kg/m 2 ) with percutaneous AT repair. Intervention(s): Athletes were randomly divided into 2 groups: an immediate group, given physical therapy from day 1 to day 84, and a traditional group, given physical therapy from day 29 to day 84. We used repeated-measures analysis of variance to compare the data.Main Outcome Measure(s): We measured MJD and PFS at days 28 (fourth week), 56 (eighth week), and 84 (12th week) after AT repair.Results: After 12 weeks of rehabilitation, we observed a large clinically meaningful effect and statistical difference between groups. At day 28, the immediate group showed higher values for PFS (P ¼ .002), MJD (P ¼ .02), and ATRS (P ¼ .002) than the traditional group. At day 56, the immediate group presented higher values for MJD (P ¼ .02) and ATRS (P ¼ .009). At day 84, the immediate group registered more MJD (P ¼ .001).Conclusions: Compared with traditional rehabilitation, 12 weeks of immediate rehabilitation after percutaneous AT repair resulted in better MJD, PFS, and ATRS after 4 weeks; better MJD and ATRS after 8 weeks; and better MJD after 12 weeks.

While the mean angle of clinical failure in human cadaveric models was 12.5° of plantarflexion, after 14.0° of plantarflexion, the percutaneous Dresden technique was found insecure for cyclical mobilization exercises, with a 5 % range of error. These findings are clinically relevant as they provide mechanical limits for diminishing the risk of Achilles lengthening during immediate rehabilitation.