Nonoperative, Dynamic Treatment of Acute Achilles Tendon Rupture: Influence of Early Weightbearing on Biomechanical Properties of the Plantar Flexor Muscle–Tendon Complex—A Blinded, Randomized, Controlled Trial

Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch; Dippmann, Christian; Ebskov, Lars Bo; Troelsen, Anders

doi:10.1053/j.jfas.2014.11.018

Cited by 33 publications

(37 citation statements)

References 28 publications

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“…Early muscle activation and ankle range of motion (ROM) are also thought to improve non-operative treatment by preventing ankle stiffness and aiding muscle recovery. 13,14 Muscle performance after completing treatment for an Achilles rupture, as measured by single-leg heel rise, is correlated with positive patient-reported outcomes and activity levels. 15 Therefore, a successful non-operative healing strategy may ideally include active recovery and motion while simultaneously preventing tendon gap formation and subsequent lengthening.…”

mentioning

confidence: 99%

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Hillin

Fryhofer

Freedman

et al. 2019

Journal Orthopaedic Research

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Conservative (non‐operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end‐to‐end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site. This study investigated the effects of ankle immobilization angle in a rat model of Achilles tendon rupture. We hypothesized that manipulating the ankle from full plantarflexion into a more dorsiflexed position during the immobilization period would result in superior hindlimb function and tendon properties, but that prolonged casting in dorsiflexion would result in inferior outcomes. After Achilles tendon transection, animals were randomized into eight immobilization groups ranging from full plantarflexion (160°) to mid‐point (90°) to full dorsiflexion (20°), with or without angle manipulation. Tendon properties and ankle function were influenced by ankle immobilization position and time. Tendon lengthening occurred after 1 week at 20° compared to more plantarflexed angles, and was associated with loss of propulsion force. Dorsiflexing the ankle during immobilization from 160° to 90° produced a stiffer, more aligned tendon, but did not lead to functional changes compared to immobilization at 160°. Although more dorsiflexed immobilization can enhance tissue properties and function of healing Achilles tendon following rupture, full dorsiflexion creates significant tendon elongation regardless of application time. This study suggests that the use of moderate plantarflexion and earlier return to activity can provide improved clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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mentioning

confidence: 99%

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Hillin

Fryhofer

Freedman

et al. 2019

Journal Orthopaedic Research

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“…There was no significant difference in heel-rise work or the ATRS. The overall rerupture rate in that study was 9% 81 .…”

Section: Achilles Tendonmentioning

confidence: 71%

What’s New in Sports Medicine

Tanksley

Werner

et al. 2015

The Journal of Bone and Joint Surgery

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“…The importance of dynamic rehabilitation with nonoperative treatment is agreed upon, but weight-bearing status remains controversial. In a randomized controlled trial, Barfod et al compared the outcomes of nonoperatively treated patients who were allowed immediate, full weight-bearing with those who were only allowed to weight-bear 6 weeks after the initiation of treatment 26 . At 1 year of follow-up, the Achilles tendon Total Rupture Score (ATRS) and heel-rise work results were similar between the groups, although the health-related quality-of-life score was significantly higher in the immediate weight-bearing group.…”

Section: Achilles Tendon Rupturementioning

confidence: 99%

What’s New in Foot and Ankle Surgery

Yeranosian

2016

The Journal of Bone and Joint Surgery

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Nonoperative, Dynamic Treatment of Acute Achilles Tendon Rupture: Influence of Early Weightbearing on Biomechanical Properties of the Plantar Flexor Muscle–Tendon Complex—A Blinded, Randomized, Controlled Trial

Cited by 33 publications

References 28 publications

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

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What’s New in Foot and Ankle Surgery

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