Accelerated rehabilitation following Achilles tendon repair after acute rupture – Development of an evidence-based treatment protocol

Brumann, M.; Baumbach, Sebastian Felix; Mutschler, Wolf; Polzer, Hans

doi:10.1016/j.injury.2014.06.022

Cited by 103 publications

(88 citation statements)

References 30 publications

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“…This finding is in inconsistency permanent calf muscle atrophy following Achilles tendon repair after patients' immobilization [15,16,18,21,25]. It has been shown that the rapid return to walking had a positive influence on repair, avoiding negative effects of long immobilization on tendon healing, as previously suggested [5][6][7]. A decrease in the endurance of the calf muscles in the injured limb has been indicated during the functional heel rise endurance test.…”

Section: Discussionmentioning

confidence: 84%

Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

Bąkowski

Ciemniewska-Gorzela

Talaśka

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Chronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique. Methods Minimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment. Results All of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10-100 N load followed by additional 250 cycles of 10-200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20-400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509-1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006). Conclusions The results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases. Level of evidence III

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Section: Discussionmentioning

confidence: 84%

Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

Bąkowski

Ciemniewska-Gorzela

Talaśka

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…Intriguingly, despite extensive rehabilitation efforts, muscle weakness can persist for a considerable time after surgery and may even persist decade later . This muscle weakness has been attributed to a reduction in muscle cross‐sectional area (CSA), and the persistent muscle atrophy has prompted an emphasis on early mobilization following the repair of the ruptured tendon . However, these efforts have not proven effective in counteracting the loss of muscle mass and associated function …”

Section: Introductionmentioning

confidence: 99%

“…11,13,[16][17][18][19][20][21][22] This muscle weakness has been attributed to a reduction in muscle cross-sectional area (CSA), 11,22,23 and the persistent muscle atrophy has prompted an emphasis on early mobilization following the repair of the ruptured tendon. 24 However, these efforts have not proven effective in counteracting the loss of muscle mass and associated function. 10,11,22,23 In addition to muscle atrophy, tendon length has received attention in recent years as an explanation of the suboptimal function.…”

Section: Introductionmentioning

confidence: 99%

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

et al. 2019

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We examined muscle function, muscle architecture, and tendon length bilaterally in persons who experience a functional deficit 2 years after an Achilles tendon rupture. Eleven persons were investigated on the injured compared with the uninjured side 47 ± 7 months (mean ± SD) after a tendon rupture. Heel‐rise data, plantar flexion strength, tendon resting angle 3D MRI‐determined tendon length and muscle cross‐sectional area, ultrasound‐determined fascicle length, and pennation angle were obtained. The heel‐rise test yielded reduced max height (32%), number of repetitions (54%), and work performed (61%), P < .001. Plantar flexion strength was impaired (P < .001) with the knee in extension (20%‐42%) and flexion (29%‐39%). Muscle cross‐sectional area was reduced for both the soleus (36%) and gastrocnemius muscles (46%; P < .001). Both the soleus tendon (55%) and the gastrocnemius tendon (14%) were longer (P < .001), and the fascicle length of the medial gastrocnemius was substantially reduced (18%; P < .001). The difference in heel‐rise height correlated to that of the gastrocnemius tendon elongation, r = .66, P < .05, but not soleus tendon elongation. These data show that a functional deficit after an Achilles tendon rupture is associated with an elongated soleus and gastrocnemius tendon along with a reduced soleus and gastrocnemius muscle cross‐sectional area and gastrocnemius fascicle length.

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“…A lack of muscle atrophy is generally regarded as an indicator of successful surgery and rehabilitation (3,9,17,(20)(21)(22)(23)(24)(25)(26)(27). In a study of 66 ATR patients, the contralateral calf circumference had decreased by an average of 1.2 cm (9).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Semi-Invasive “Internal Splinting” and Open Suturing Techniques in Achilles Tendon Rupture Surgery

Sarman

Müezzinoğlu

Memişoğlu

et al. 2016

The Journal of Foot and Ankle Surgery

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Accelerated rehabilitation following Achilles tendon repair after acute rupture – Development of an evidence-based treatment protocol

Cited by 103 publications

References 30 publications

Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

Comparison of Semi-Invasive “Internal Splinting” and Open Suturing Techniques in Achilles Tendon Rupture Surgery

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