The Effects of Early Mobilization in the Healing of Achilles Tendon Repair

Abstract

Twenty-four male New Zealand rabbits underwent suture repair of a tenotomy of the left achilles tendon. The rabbits were randomized into two groups of 12 animals; in group (A), the ankle was immobilized by pinning for 35 days, while in the group (B), the ankle was immobilized for only 14 days followed by active mobilization. Following sacrifice at 35 days postoperatively, the retrieved tendons were evaluated by biomechanical testing and histologic examination. Approximately 50% of stretching occurred in the first four days; average overall elongation was 9.5+/-1.0 mm and 12.7+/-1.5 mm (p=0.102) and average stiffness recovery was 67.4+/- 2.0% and 82.9 +/- 1.9% (p=0.0004) for groups A and B respectively. Histologically both groups demonstrated traces of disorganized neo-collagen fibers at the repair site as early as the fourth day with subsequent appearance of more mature collagen. The results obtained from our study favor early mobilization of the repaired tendon, which seems to restore the functional properties of the tendons more rapidly than continuous immobilization of an identical surgical repair.

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

“…Under loading conditions, cells within the ligament sense tissue strains and respond by modifying the tissue. Mobilization for the treatment of soft tissue damage has also been found to decrease muscle atrophy, osteoporosis, adhesions, and joint stiffness following injury [125][126][127][128][129][130][131]. According to a review by Hurley and Roth, studies have indicated that, even in healthy and diseased older adults, short-term high-intensity strength training is well tolerated and helps reduce proinflammatory cytokines and knee joint loads.…”

Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

“…4,8,10,23 Hypoxiaand mechanically induced degenerative changes can arise from this behavior; histologic findings 5,6,10 have demonstrated that spontaneous AT ruptures occur in these patients, with nonuniform distribution of stress resulting in vascular injury due to ischemic torque placed on the AT. Therefore, in addition to an adequate postoperative intervention plan, these patients require lessons in appropriate techniques for sport reintegration and regular sport practice.…”

“…3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,[21][22][23] to promote better clinical outcomes than are typical with open or traditional rehabilitation programs. 3,5,6,8,10,16,22,23 Traditional models do not appear to provide the tissue and neuromuscular benefits that early models provide. 3,6,10,16,[21][22][23] Indeed, they result in pathologic adaptations to plantar-flexion tasks.…”

“…3,5,6,8,10,16,22,23 Traditional models do not appear to provide the tissue and neuromuscular benefits that early models provide. 3,6,10,16,[21][22][23] Indeed, they result in pathologic adaptations to plantar-flexion tasks. 12 For example, using velocityencoded cine phase-contrast magnetic resonance images, Finni et al 12 found greater velocity and displacement of the medial gastrocnemius about the deep plantar flexors during submaximal isometric voluntary contractions 13 weeks after AT repair in patients treated with traditional rehabilitation compared with healthy control participants.…”

“…The other begins with some degree of immobilization or non-weight bearing in the first 4 weeks after AT repair, normally via a rest period during the first 2 weeks after surgery. 21 Currently, managing AT rehabilitation after operative repair remains controversial 1,2,4,5,8,16,22 because of the unknown mechanical tolerances of different operative techniques 4,6 for preventing clinical failure 22 ; the comorbidities associated with traditional management, [3][4][5][6]8,14,16,22 such as muscle atrophy, adherences, delayed collagen remodeling, thromboembolism, and high rerupture rates [2][3][4][5][6]22,23 ; and the risks and complications that can occur during early rehabilitation, 3,4,6,15,21,22 such as tendinous elongation and early reruptures. 3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,…”