Early mobilization after operative repair of ruptured Achilles tendon

Saw, Y.; Baltzopoulos, Vasilios; Lim, A; Rostron, P.K.M.; Bolton-Maggs, BG; Calver, Ronelle

doi:10.1016/0020-1383(93)90155-y

Cited by 43 publications

(22 citation statements)

References 18 publications

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“…7,1o,12,15,18,2o These studies have reported no reruptures (one report of a partial rerupture), but have also reported minor (superficial wound infections, sensory loss, and tendocutaneous adhesions) or major surgical (deep infection and pulmonary embolus) complications. ' , 10,11,12,15,18,19,20 The current study was designed to: 1. evaluate the clinical results of repair of acute ruptures of the Achilles tendon utilizing the triple bundle technique 9,10,16,21 followed by early ankle range of motion exercises, and 2. compare these results to nonoperative cast treatment with delayed ankle range of motion exercises.…”

Section: Introductionmentioning

confidence: 99%

Early Ankle Motion after Triple Bundle Technique Repair vs. Casting for Acute Achilles Tendon Rupture

et al. 2001

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The purpose of our study is to evaluate the triple bundle technique for acute Achilles tendon rupture repair followed by early (at 14 days) postoperative ankle range of motion compared to nonoperative treatment with delayed ankle range of motion. We retrospectively reviewed 73 patients with an acute Achilles tendon rupture treated with either a plantar flexed cast or surgical repair. We found operative treatment reduces immobilization time, allows safe early return to weight-bearing, and diminishes risk of rerupture compared to nonoperative treatment. However, at an average follow-up of greater than 3.5 years, there was no statistical difference in AOFAS hindfoot scores, strength, or patient satisfaction between the two groups. Significant complications were higher in the nonoperative group manifested by three reruptures (7.7%) vs. one deep wound dehiscence in the operative group (3%).

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Section: Introductionmentioning

confidence: 99%

Early Ankle Motion after Triple Bundle Technique Repair vs. Casting for Acute Achilles Tendon Rupture

et al. 2001

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“…2 However, new controversy has arisen from recent studies that show that early mobilisation seems to enhance the healing of the repair. [3][4][5][6][7][8][9] Many authors are now advocating early range of motion (ROM) based on animal [10][11][12][13][14] and hand studies 15 that show increased healing rates and strength while preventing the side eVects of prolonged joint immobilisation, such as joint stiVness, muscular atrophy, cartilage atrophy, deep vein thrombosis, tendocutaneous adhesions, skin necrosis, and disuse osteoporosis. 2 8 16 17 If the tendon experiences tension during healing, orientation of collagen fibres and strength of the calf muscles are improved, as are tendon vascularity, 11-13 18 breaking strength, and number of collagen filaments.…”

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confidence: 99%

The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair

Akizuki

Gartman²,

Nisonson³

et al. 2001

Br J Sports Med

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Background-After Achilles tendon repair, immediate weightbearing and immobilisation closer to neutral plantarflexion are thought to limit atrophy and stiVness, but may place deleterious stress on the repair. Objectives-To estimate the relative stress on the Achilles tendon during weightbearing with immobilisation in varying degrees of plantarflexion. Conclusions-When the ankle is immobilised, stress on the Achilles tendon is determined by the degree of plantarflexion and the contractile activity of the plantarflexors. In the immobilised ankle, the addition of a 1 inch heel lift was suYcient to minimise plantarflexor activity during walking. (Br J Sports Med 2001;35:329-334) Keywords: Achilles tendon; EMG; heel lifts; soleus; gastrocnemius Although there is still some debate about open versus closed management of Achilles tendon disruption, 1 2 most authors agree that surgical repair is the treatment of choice. Until recently, surgical repair followed by cast immobilisation in plantarflexion and non-weightbearing for six weeks was considered the ideal treatment. However, new controversy has arisen from recent studies that show that early mobilisation seems to enhance the healing of the repair. Methods-Electromyographic3-9 Many authors are now advocating early range of motion (ROM) based on animal 10-14 and hand studies 15 that show increased healing rates and strength while preventing the side eVects of prolonged joint immobilisation, such as joint stiVness, muscular atrophy, cartilage atrophy, deep vein thrombosis, tendocutaneous adhesions, skin necrosis, and disuse osteoporosis.2 8 16 17 If the tendon experiences tension during healing, orientation of collagen fibres and strength of the calf muscles are improved, as are tendon vascularity, 11-13 18 breaking strength, and number of collagen filaments. 19 With early ROM and weightbearing protocols, patients are obtaining power and strength that is almost equal to that of the opposite good leg.3 5 6 8 By contrast, repair followed by six weeks of cast immobilisation results in appreciable residual weakness. 1 20-22 Early ROM and progressive weightbearing appear to result in few failures or complications.5 23-25 However, there is limited clinical research available on which to base the timing and progression of rehabilitation after Achilles tendon repair. For example, cam-walkers are commonly used to provide protected weightbearing by immobilising the ankle in varying degrees of plantarflexion. However, the degree of protection aVorded to the Achilles tendon with the use of such immobilisers is not known.When the ankle is immobilised, stress on the Achilles tendon during gait is determined by the degree of plantarflexion and the contractile activity of the plantarflexors. The degree of plantarflexion can be controlled by using a ROM adjustable cam-walker. Alternatively, cam-walkers with the axis fixed at 90°can be used, and increased plantarflexion can be achieved by inserting heel lifts into the camwalker. The magnitude of contractile activity during...

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“…Also, it may be related to the skin contracture that is frequently present around the tendon in these patients. We are aware that, given the secure suturing of the tendon that is presently advocated, 28,29 patients could mobilize early, and that immobilization in a gravity equinus cast is probably not necessary. 30 However, the seriousness of the condition dictated that the repair had to be protected.…”

Section: Discussionmentioning

confidence: 99%