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Feng SM, Maffulli N, Oliva F, Saxena A, Hao YF, Hua YH, Xu HL, Tao X, Xu W, Migliorini F, Ma C. Surgical management of chronic Achilles tendon rupture: evidence-based guidelines. J Orthop Surg Res 2024; 19:132. [PMID: 38341569 PMCID: PMC10858558 DOI: 10.1186/s13018-024-04559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes. METHODS A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines. RESULTS Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol. CONCLUSION Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University "La Sapienza", Rome, Italy
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-On-Trent, Staffordshire, ST4 7QB, England
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesco Oliva
- Department of Sports Traumatology, Universita' Telematica San Raffaele, Rome, Italy
| | - Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA, USA
| | - Yue-Feng Hao
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Ying-Hui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedic, People's Hospital, Peking University, Beijing, People's Republic of China
| | - Xu Tao
- Department of Sports Medicine, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China
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Mitrogiannis L, Mitrogiannis G, Melaki K, Karamitros A, Karantanas A, Paxinos O. An Early Functional Unsupervised Rehabilitation Protocol Allows Safe Return to Function After Achilles Tendon Repair. Cureus 2024; 16:e52477. [PMID: 38371156 PMCID: PMC10873818 DOI: 10.7759/cureus.52477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE Acute Achilles tendon tears in young active individuals are often treated surgically with prolonged rehabilitation, with the leg initially immobilized in plantar flexion in serial non-weight bearing casts and gradually progressing to full weight bearing. This study aimed to evaluate the safety of an early functional unsupervised rehabilitation protocol. METHODS The medical records of 25 patients treated with open repair were available for follow-up. In 10 patients, an early functional unsupervised rehabilitation protocol was used with a removable cast, active range of motion exercises of the ankle from the first postoperative day, and full weight bearing in a walking boot with the foot plantigrade after the second week. Another 15 patients who followed the classic rehabilitation protocol were used as controls. The patients were evaluated with the Victorian Institute of Sports Assessment-Achilles (VISA-A) and an ultrasound examination-based score. A Wilcoxon test was used to compare the scores between the groups. RESULTS The mean VISA-A score was 90.1 (SD = 9.87) for the early functional rehabilitation protocol group, while it was 83.8 (SD = 17.06, p = 0.624) for the control group. The mean ultrasound score was 7.75 (SD = 1.71) for the early functional rehabilitation protocol group, while it was 7.60 (SD = 3.05, p = 0.414) for the control group. There were no intra- or early postoperative complications in the groups, and all patients were satisfied with the results of their operation. CONCLUSIONS An early unsupervised functional rehabilitation protocol after open Achilles repair may allow for safe early mobilization and minimize the need for physiotherapy. The small number of participants is a limitation of this study, and further evaluation with more patients is necessary to document the efficacy.
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Affiliation(s)
| | - George Mitrogiannis
- Orthopedics Department, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Kalliopi Melaki
- Radiology Department, General Hospital of Piraeus "Tzaneio", Athens, GRC
| | | | | | - Odysseas Paxinos
- Orthopedics Department, 251 Hellenic Air Force General Hospital, Athens, GRC
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Warneke K, Lohmann LH, Keiner M, Wagner CM, Schmidt T, Wirth K, Zech A, Schiemann S, Behm D. Using Long-Duration Static Stretch Training to Counteract Strength and Flexibility Deficits in Moderately Trained Participants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13254. [PMID: 36293831 PMCID: PMC9603712 DOI: 10.3390/ijerph192013254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Many sports injuries result in surgery and prolonged periods of immobilization, which may lead to significant atrophy accompanied by loss of maximal strength and range of motion and, therefore, a weak-leg/strong-leg ratio (as an imbalance index ∆ ) lower than 1. Consequently, there are common rehabilitation programs that aim to enhance maximal strength, muscle thickness and flexibility; however, the literature demonstrates existing strength imbalances after weeks of rehabilitation. Since no study has previously been conducted to investigate the effects of long-duration static stretch training to treat muscular imbalances, the present research aims to determine the possibility of counteracting imbalances in maximal strength and range of motion. Thirty-nine athletic participants with significant calf muscle imbalances in maximal strength and range of motion were divided into an intervention group (one-hour daily plantar flexors static stretching of the weaker leg for six weeks) and a control group to evaluate the effects on maximal strength and range of motion with extended and bent knee joint. Results show significant increases in maximal strength (d = 0.84-1.61, p < 0.001-0.005) and range of motion (d = 0.92-1.49, p < 0.001-0.002) following six weeks of static stretching. Group * time effects (p < 0.001-0.004, η² = 0.22-0.55) revealed ∆ changes in the intervention group from 0.87 to 1.03 for maximal strength and from 0.92 to 1.11 in range of motion. The results provide evidence for the use of six weeks of daily, one hour stretching to counteract muscular imbalances. Related research in clinical settings after surgery is suggested.
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Affiliation(s)
- Konstantin Warneke
- Department for Exercise, Sport and Health, Leuphana University, 21335 Lüneburg, Germany
| | - Lars H. Lohmann
- Institute of Sport Science, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
| | - Michael Keiner
- Department of Training Science, German University of Health & Sport, 85737 Ismaning, Germany
| | - Carl-M. Wagner
- Department of Training Science, German University of Health & Sport, 85737 Ismaning, Germany
| | - Tobias Schmidt
- Department Training and Testing Science, Medical School Hamburg, 20457 Hamburg, Germany
| | - Klaus Wirth
- Sport and Exercise Sciences, University of Applied Sciences, 2700 Wiener Neustadt, Austria
| | - Astrid Zech
- Department of Human Motion Science and Exercise Physiology, Friedrich Schiller University, 07743 Jena, Germany
| | - Stephan Schiemann
- Department for Exercise, Sport and Health, Leuphana University, 21335 Lüneburg, Germany
| | - David Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
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Mosconi M, Pasta G, Annunziata S, Guerrieri V, Ghiara M, Perelli S, Torriani C, Grassi FA, Jannelli E. Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison. Diagnostics (Basel) 2022; 12:1824. [PMID: 36010175 PMCID: PMC9406849 DOI: 10.3390/diagnostics12081824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND the incidence of Achilles tendon (AT) rupture is rising; however, there is no clear consensus regarding the optimal treatment. The aim of this retrospective study was to compare instrumental and patient-reported outcome scores after fast functional rehabilitation (group A) versus plaster cast immobilization (group B) programs in patients who underwent AT tenorrhaphy. METHODS 33 patients, with similar clinical and demographic features, underwent open AT tenorrhaphy between January and July 2018. Of these, 15 patients were treated with fast functional rehabilitation program (group A), and 18 patients were treated with plaster cast immobilization protocol (group B). Sural triceps hypotrophy and functional scores (American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, and Achilles tendon Total Rupture Score (ATRS)) were recorded at a 12-month follow-up. Ultrasonography (US) and elastosonography (ES) were used to compare the characteristics of the tendons after surgery. RESULTS At 12 months, no significant differences in any of the patient-reported outcomes or the instrumental measurement tests were seen between the two groups. CONCLUSIONS fast functional rehabilitation after AT surgical repair is safe, effective, and may be the first choice of treatment, especially in young, collaborative, and active patients.
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Affiliation(s)
- Mario Mosconi
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
- Specialization School in Orthopaedics and Traumatology, University of Pavia, 27100 Pavia, Italy
| | - Gianluigi Pasta
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
| | - Salvatore Annunziata
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
- Specialization School in Orthopaedics and Traumatology, University of Pavia, 27100 Pavia, Italy
| | - Viviana Guerrieri
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
- Specialization School in Orthopaedics and Traumatology, University of Pavia, 27100 Pavia, Italy
| | - Matteo Ghiara
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
| | - Simone Perelli
- Institut CAtalá de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, 08028 Barcelona, Spain;
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Hospital Del Mar, Universitat Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Camilla Torriani
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
| | - Federico Alberto Grassi
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
- Specialization School in Orthopaedics and Traumatology, University of Pavia, 27100 Pavia, Italy
| | - Eugenio Jannelli
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.M.); (G.P.); (V.G.); (M.G.); (C.T.); (F.A.G.); (E.J.)
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Hoeffner R, Svensson RB, Bjerregaard N, Kjær M, Magnusson SP. Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:7445398. [PMID: 38655161 PMCID: PMC11022787 DOI: 10.1155/2022/7445398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 04/26/2024]
Abstract
Persistent muscle weakness, tendon elongation, and incomplete return to preinjury level are frequent sequelae after acute Achilles tendon rupture, and evidence-based knowledge of how to best rehabilitate the injury is largely absent in the literature. The objective of this review is to illuminate and discuss to what extent an Achilles tendon rupture affects muscle, tendon, and function when assessed with the Achilles tendon total rupture score (ATRS), muscle strength, muscle cross-sectional area, tendon length, and the heel-rise test. The patient-reported outcome measures (PROM) data in the literature suggest that the recovery takes longer than 6 months (ATRS, 70 out of 100), that one-year postinjury, the ATRS only reaches 82, and that this does not appear to noticeably improve thereafter. Loss of muscle mass, strength, and function can in some cases be permanent. Over the first 6 months postinjury, the tendon undergoes elongation, which appears to be negatively correlated to heel-rise function. More recently, there has been some interest in how muscle length and excursion is related to the reduced function. The available literature indicates that further research is highly warranted and that efforts to restore normal tendon length may improve the likelihood of returning to preinjury level after an Achilles tendon rupture.
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Affiliation(s)
- Rikke Hoeffner
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rene B. Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bjerregaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Kjær
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Won Lee K, Bae JY, Ho BC, Kim JH, Seo DK. Immediate Weightbearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair. J Foot Ankle Surg 2022; 61:604-608. [PMID: 34785129 DOI: 10.1053/j.jfas.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/29/2018] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
The incidence of Achilles tendon rupture is increasing. Postoperative rehabilitation after repairing acute Achilles tendon rupture is very important because the choice of treatment during the rehabilitation period can influence the results. Moreover, the method of functional rehabilitation varies and is developing steadily. Recent studies recommend a functional rehabilitation protocol, and this approach is accepted widely. This study aimed to introduce our most accelerated functional rehabilitation protocol following surgery for acute Achilles tendon rupture and to review the results retrospectively. From July 2014 to July 2016, 67 patients underwent surgery for acute Achilles tendon rupture by one surgeon. Age, sex, body mass index, injury mechanism, rehabilitation method and progress, time to return to previous physical activity, and complications were evaluated. The mean time to be able to squat fully was 10 ± 4.7 (4-20) weeks. Full squatting was possible in 92.8% (52 patients). The mean time to perform a single-limb heel rise and repetitive single-limb heel rise was 12.6 ± 3.9 (6-24) and 23.3 ± 7.7 (8-40) weeks, respectively. The mean time to return to sports was 20.6 ± 5.2 (12-32) weeks. The major complication rate was 3.5% (one re-rupture and one tendon elongation). The mean pre- and postoperative Achilles Tendon Total Rupture Score was 29.5 ± 3.7 (20-38) and 79.3 ± 18.5 (20-98) points, respectively. The increase was significant (p < .01). In conclusion, immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results.
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Affiliation(s)
- Ki Won Lee
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Joo-Yul Bae
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Byeong Cheol Ho
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Joon Hee Kim
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Dong-Kyo Seo
- Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea.
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Postoperative Rehabilitation Following Achilles Tendon Repair: A Systematic Review. Sports Med Arthrosc Rev 2021; 29:130-145. [PMID: 33972490 DOI: 10.1097/jsa.0000000000000309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The optimal postoperative management of Achilles tendon (AT) rupture remains unknown. The past 2 decades have witnessed a trend toward less rigid immobilization, earlier weightbearing, and accelerated functional rehabilitation postoperatively. The objective of this study was to identify all high-quality studies pertaining to rehabilitation after AT repair and characterize the various rehabilitation protocols that have been described. A systematic review of the English-language literature was performed according to PRISMA guidelines. All included studies represented level 1, 2, or 3 evidence and examined postoperative rehabilitation protocols following the repair of an acute AT rupture. A total of 1187 subjects were included. Surgical technique, rehabilitation protocol, and outcome assessment varied widely between studies. Early postoperative weightbearing with less rigid immobilization appears to accelerate short-term functional recovery. An aggressive rehabilitation program may also be advantageous in the short term, but further studies are needed to determine the long-term effects of these accelerated physical therapy and return-to-play protocols.
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Xu XY, Gao S, Lv Y, Zhou F, Jiao C, Fan JX, Zhu TJ. Duration of immobilisation after Achilles tendon rupture repair by open surgery: a retrospective cohort study. J Orthop Surg Res 2021; 16:196. [PMID: 33731160 PMCID: PMC7968267 DOI: 10.1186/s13018-021-02342-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background The best treatment for acute Achilles tendon ruptures remains controversial. No cohort studies have compared different immobilisation durations after open surgery. This retrospective cohort study aimed to determine the optimal duration of immobilisation after this surgery. Methods A total of 266 patients with acute Achilles tendon rupture were divided into 4 groups (A, B, C, and D) according to immobilisation duration of 0, 2, 4, and 6 weeks, respectively. All patients underwent the same suture technique with a similar rehabilitation protocol and were examined clinically at 2, 4, 6, 8, 10, 12, 14, 16, 24, and 48 weeks, with a final follow-up at a mean of 22.3 months postoperatively. The primary outcome was the time of return to light sports activity (LSA). Secondary outcomes included range of motion (ROM) and single-legged heel rise height (SHRH). Data on operation time, complications, visual analogue pain scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and Achilles tendon Total Rupture score (ATRS) were also collected. Demographic baseline data were analysed using one-way analysis of variance; outcome parameters were analysed using Kruskal-Wallis H test, and complications were analysed using Fisher’s exact test. Statistical significance was considered at P ≤ 0.05. Results VAS scores decreased significantly, reaching 0 in all groups after 12 weeks. The AOFAS and ATRS scores were significantly different between the groups from weeks 2 to 12 (P<0.001) and weeks 2 to 16 (P<0.001), respectively. All the mean scores showed better results in group B than in the other groups. In terms of recovery time of ROM, SHRH, and LSA, groups A and B were significantly faster than groups C and D (P<0.001). There were 13 (13/266, 4.9%) complications: 5 superficial infections, 3 deep venous thrombosis, and 5 trauma-related re-ruptures. On the last follow-up, all complications had recovered. There were no significant differences in complications between the groups. Conclusions Immobilisation for 2 weeks after this open surgery is the best choice for early rehabilitation and weight-bearing while minimising pain and other complications.
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Affiliation(s)
- Xiang Yu Xu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Shan Gao
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Yang Lv
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China.
| | - Fang Zhou
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China.
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Ji Xing Fan
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Teng Jiao Zhu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
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Tarantino D, Palermi S, Sirico F, Corrado B. Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. J Funct Morphol Kinesiol 2020; 5:jfmk5040095. [PMID: 33467310 PMCID: PMC7804867 DOI: 10.3390/jfmk5040095] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. Achilles tendon ruptures (ATRs) mainly occur during sports activities, and their incidence has increased over the last few decades. Achilles tendon tears necessitate a prolonged recovery time, sometimes leaving long-term functional limitations. Treatment options include conservative treatment and surgical repair. There is no consensus on which is the best treatment for ATRs, and their management is still controversial. Limited scientific evidence is available for optimized rehabilitation regimen and on the course of recovery after ATRs. Furthermore, there are no universally accepted outcomes regarding the return to play (RTP) process. Therefore, the aim of this narrative review is to give an insight into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP.
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Resistance Exercises in Early Functional Rehabilitation for Achilles Tendon Ruptures Are Poorly Described: A Scoping Review. J Orthop Sports Phys Ther 2020; 50:681-690. [PMID: 33094667 PMCID: PMC8168134 DOI: 10.2519/jospt.2020.9463] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. DESIGN Scoping review. LITERATURE SEARCH We searched the MEDLINE, Embase, CINAHL, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases. STUDY SELECTION CRITERIA Randomized controlled trials, cohort studies, and case series (10 or more participants) that reported using resistance exercise in the immobilization period in the first 8 weeks of treatment for acute Achilles tendon rupture were included. DATA SYNTHESIS Completeness of exercise description was assessed with the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier exercise descriptor framework. RESULTS Thirty-eight studies were included. Fifty-one resistance exercises were extracted and categorized as isometric exercises (n = 20), heel raises (n = 6), strengthening with external resistance (n = 13), or unspecified (n = 12). A median of 8 (interquartile range, 6-10) of a possible 19 CERT items was reported. The amount of items described of the 13 Toigo and and Boutellier exercise descriptors ranged from 0 to 11. CONCLUSION A variety of resistance exercises targeted at the ankle plantar flexors were used as part of early functional rehabilitation after Achilles tendon rupture. However, most studies provided inadequate description of resistance exercise interventions. J Orthop Sports Phys Ther 2020;50(12):681-691. Epub 23 Oct 2020. doi:10.2519/jospt.2020.9463.
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Zellers JA, Christensen M, Kjær IL, Rathleff MS, Silbernagel KG. Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119884071. [PMID: 31803789 PMCID: PMC6878623 DOI: 10.1177/2325967119884071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early functional rehabilitation is frequently discussed in treating Achilles tendon rupture. A consistent definition of what constitutes early functional rehabilitation has not been established across the literature, despite studies supporting its efficacy. A standardized definition would be helpful to pool data across studies, allow for between-study comparisons, and ultimately work toward developing clinical guidelines. PURPOSE To define early functional rehabilitation (including when it is initiated and what it entails) when used to treat Achilles tendon rupture and to identify outcome measures for evaluating the effect of treatment. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Ovid MEDLINE, EMBASE, PEDro, CINAHL, and Cochrane databases were searched for relevant studies. Eligibility criteria for selecting studies consisted of randomized controlled trials, cohort studies, and case series (≥10 participants) including weightbearing or exercise-based interventions within 8 weeks after Achilles tendon rupture. RESULTS A total of 174 studies published between 1979 and 2018 were included. Studies were rated a median (interquartile range [IQR]) of 17 (15-20) on the Downs & Black checklist and included 9098 participants. Early functional rehabilitation incorporated weightbearing (95%), range of motion (73%), and isometric/strengthening exercises (50%). Weightbearing was initiated within the first week, whereas exercise (eg, ankle range of motion, strengthening, whole-body conditioning) was initiated in the second week. Initiation of exercises varied based on whether treatment was nonsurgical (mean, 3.0 weeks; IQR, 2.0-4.0 weeks) or simple (mean, 2.0 weeks; IQR, 0.0-2.3 weeks) or augmented surgical repair (mean, 0.5 weeks; IQR, 0.0-2.8 weeks) (P = .017). Functional outcomes including ankle range of motion (n = 84) and strength (n = 76) were reported in 130 studies. Other outcome domains included patient-reported outcomes (n = 89), survey-based functional outcomes (n = 50), and tendon properties (n = 53). CONCLUSION Early functional rehabilitation includes weightbearing and a variety of exercise-based interventions initiated within the first 2 weeks after acute Achilles tendon rupture/repair. Because early functional rehabilitation has lacked a standardized definition, interventions and outcome measures are highly variable, and pooling data across studies should be done with attention paid to what was included in the intervention and how treatment was assessed.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Marianne Christensen
- Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Inge Lunding Kjær
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Mu Y, Ma Y, Yang W, Diao Y, Qiao Z, Liu W, Luo Y, Yin L. [Biomechanical comparison study of two ultra-strong sutures in repair of Achilles tendon via panda rope bridge technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1147-1150. [PMID: 31512457 DOI: 10.7507/1002-1892.201811038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the biomechanical properties of two ultra-strong sutures and suturing methods in panda rope bridge technique (PRBT) application, and provide guidance for clinical selection of suture threads and suture methods. Methods Forty Achilles tendons from bulls were randomly divided into 4 groups ( n=10) and transected at the 4 cm proximal to the tendon insertion. Groups A and B used Ethibond sutures (USP 5), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed through a calcaneus canal. Groups A and B had 4 and 8 threads through the stump plane, respectively. Groups C and D used Ultrabraid sutures (USP 2), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed in the calcaneus with two anchors. Groups C and D had 4 and 8 threads through the stump plane, respectively. The dynamic tensile forces of 20-100, 20-200, 20-300, and 20-400 N were tested respectively by using a dynamic tensile testing machine at 0.5 Hz for 250 cycles. After each stage of testing, the gap between stumps was measured with a caliper and the type of suture failure was recorded. Results After dynamic tensile forces of 20-100 N and 20-200 N, the gaps of the four groups arranged from small to large were groups D, B, C, and A. The differences between groups A and B and groups C and D were significant ( P<0.05). But after dynamic tensile forces of 20-300 N and 20-400 N, the gaps were more than 5 mm in all groups. The suture retention rates of the four groups after dynamic tensile forces of 20-100 N and 20-200 N were all 100%. The suture retention rates of groups A, B, C, and D were 0, 80%, 60%, and 100%, respectively after dynamic tensile forces of 20-300 N. The differences of suture retention rates between group A and groups B and D were significant ( P<0.05). There was no significant difference between groups B, C, and D ( P>0.05). After dynamic tensile forces of 20-400 N, the suture retention rates of groups A, B, C, and D were 0, 50%, 0, and 70%, respectively. There were significant differences between groups A and B and groups C and D ( P<0.05). Conclusion Repairing Achilles tendon rupture via PRBT with 8 ultra-strong sutures through the stump plane can meet the mechanical requirements for walking by using ankle boots and heel pads in the early accelerated rehabilitation after operation.
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Affiliation(s)
- Yuan Mu
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Yingxuan Ma
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Wei Yang
- Bioengineering College of Chongqing University, Chongqing, 400044, P.R.China
| | - Yulei Diao
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Zhao Qiao
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Wenke Liu
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Yanfeng Luo
- Bioengineering College of Chongqing University, Chongqing, 400044, P.R.China
| | - Liangjun Yin
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010,
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Lu J, Liang X, Ma Q. Early Functional Rehabilitation for Acute Achilles Tendon Ruptures: An Update Meta-Analysis of Randomized Controlled Trials. J Foot Ankle Surg 2019; 58:938-945. [PMID: 31474405 DOI: 10.1053/j.jfas.2018.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Indexed: 02/03/2023]
Abstract
The aim of this study was to investigate the role of early functional rehabilitation in acute Achilles tendon ruptures. Eligible studies were identified from PubMed, Embase, and the Cochrane Library using the following search keywords: "Achilles tendon rupture" and "rehabilitation" or "function" or "functional" or "mobilization" and "randomized" or "random" or "blind" or "control" or "compare" or "comparative." A heterogeneity test based on I2 statistic and Cochran's Q test was conducted. The pooled risk ratio and weighted mean difference with 95% confidence interval was calculated for each outcome using the random-effect (p < .05 or I2 > 50% for significant heterogeneity) or fixed-effect (p > .05 or I2 < 50% for nonsignificant heterogeneity) model. A subgroup analysis was also performed. Fourteen randomized controlled trials were identified. Pooled data demonstrated no difference in the complication rates, time taken to return to sports, total number of patients returning to work or sports, and satisfaction rate between the early functional rehabilitation and conventional cast immobilization groups. Early functional rehabilitation significantly decreased the time taken to return to work (weighted mean difference -1.56; 95% confidence interval -3.09 to 0.04; p = .04]. Early functional rehabilitation for acute Achilles tendon ruptures appeared to be related to a shorter time taken to return to work; however, it did not affect the other variables between the groups.
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Affiliation(s)
- Jun Lu
- Surgeon, Foot and Ankle Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Xiaojun Liang
- Professor, Foot and Ankle Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Qiang Ma
- Surgeon, Foot and Ankle Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China.
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Agres AN, Gehlen TJ, Arampatzis A, Taylor WR, Duda GN, Manegold S. Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture. Gait Posture 2018; 62:179-185. [PMID: 29554516 DOI: 10.1016/j.gaitpost.2018.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 02/23/2018] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although early functional rehabilitation (EFR) has been suggested to yield rapid functional recovery after Achilles tendon rupture (ATR) compared to conventional rehabilitation (CR), most quantitative assessments occur long after rehabilitation has been completed. Few data exist regarding the short-term functional gains during the healing period post-ATR. It remains unclear if EFR allows for an objectively faster return to function. The aim of this study was to examine EFR's effect on gait, plantarflexor strength, and tendon properties in early post-operative follow-ups. METHODS Fourteen patients received either EFR (n = 6) or CR (n = 8) after percutaneous ATR repair. Functional gait analysis, maximal voluntary isometric contractions (MVICs), and Achilles tendon properties were assessed at 8 and 12 weeks post-op. RESULTS Comparison of EFR against CR yielded no statistically significant differences in ankle kinematics or kinetics, Achilles tendon properties or MVICs on the injured (INJ) ankle at either time point. During gait, only CR patients demonstrated significantly lower plantarflexion moments on INJ at 8 weeks (0.817 ± 0.151 N·m/kg vs. 1.172 ± 0.177 N·m/kg, p = 0.002). All patients exhibited deficits in plantarflexor moment at 8 weeks and eversion moment at 12 weeks on INJ during gait that had effect sizes of note when compared to CON. SIGNIFICANCE ATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.
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Affiliation(s)
- Alison N Agres
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Germany.
| | - Tobias J Gehlen
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Germany
| | | | | | - Georg N Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Germany
| | - Sebastian Manegold
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Germany
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15
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Farcic TS, Baldan CS, Machado AFP, Caffaro LAM, Masson IFB, Casarotto RA. Collagen Fibers in the Healing Process of Rat Achilles Tendon Rupture Using Different Times of Ultrasound Therapy. Adv Wound Care (New Rochelle) 2018; 7:114-120. [PMID: 29696098 DOI: 10.1089/wound.2017.0748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/29/2017] [Indexed: 11/12/2022] Open
Abstract
Objective: The aim of this study was to evaluate the organization of collagen fibers in the healing process of rat Achilles tendon rupture using different times of ultrasound therapy (TUS). Approach: Forty Wistar rats were selected. Among these, 32 were submitted to total tenotomy of the calcaneous tendon and divided into 5 groups: control group (CG, n = 8), without tenotomy or any treatment; tenotomy group (n = 8), with tenotomy and without treatment; TUS groups-TUS3 (n = 8), TUS4 (n = 8), and TUS5 (n = 8)-submitted to tenotomy and treated with TUS for 3, 4, and 5 min per effective radiating area (ERA), respectively. The animals were sacrificed on the 12th postoperative day. The tendons were surgically removed for analysis of the collagen fiber organization using the birefringence technique (OR, optical retardation). Results: The collagen fibers exhibited better aggregation and organization in the UST3, TUS4, and TUS5 groups compared with CG (p < 0.05). The TUS5 group had better response rates in intergroup comparison. Innovation: The dose response of therapeutic TUS is influenced by many variables. The scientific evidence to support the dosimetry is insufficient. The application time is an important variable to be considered in TUS. In this study, the longer the application time, the better for organization and aggregation of collagen fibers in the rat tendon. Conclusion: TUS applied for 5 min per ERA presented higher dose response to the organization of collagen fibers in the healing process of rat Achilles tendon rupture.
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Affiliation(s)
- Thiago Saikali Farcic
- Department of Physical Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Department of Physical Therapy, Universidade Paulista (UNIP), São Paulo, Brazil
| | - Cristiano Schiavinato Baldan
- Department of Physical Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Department of Physical Therapy, Universidade Paulista (UNIP), São Paulo, Brazil
| | - Aline Fernanda Perez Machado
- Department of Physical Therapy, Universidade Paulista (UNIP), São Paulo, Brazil
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | | | - Raquel Aparecida Casarotto
- Department of Physical Therapy, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Boden SA, Boden AL, Mignemi D, Bariteau JT. Liquifying PLDLLA Anchor Fixation in Achilles Reconstruction for Insertional Tendinopathy. Foot Ankle Spec 2018; 11:162-167. [PMID: 29134816 DOI: 10.1177/1938640017740676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Insertional Achilles tendinopathy (IAT) is a frequent cause of posterior heel pain and is often associated with Haglund's deformity. Surgical correction for refractory cases of IAT has been well studied; however, the method of tendon fixation to bone in these procedures remains controversial, and to date, no standard technique has been identified for tendon fixation in these surgeries. Often, after Haglund's resection, there is large exposed cancellous surface for Achilles reattachment, which may require unique fixation to optimize outcomes. Previous studies have consistently demonstrated improved patient outcomes after Achilles tendon reconstruction with early rehabilitation with protected weight bearing, evidencing the need for a strong and stable anchoring of the Achilles tendon that allows early weight bearing without tendon morbidity. In this report, we highlight the design, biomechanics, and surgical technique of Achilles tendon reconstruction with Haglund's deformity using a novel technique that utilizes ultrasonic energy to liquefy the suture anchor, allowing it to incorporate into surrounding bone. Biomechanical studies have demonstrated superior strength of the suture anchor utilizing this novel technique as compared with prior techniques. However, future research is needed to ensure that outcomes of this technique are favorable when compared with outcomes using traditional suture anchoring methods. LEVELS OF EVIDENCE Level V: Operative technique.
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Affiliation(s)
- Stephanie A Boden
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
| | - Allison L Boden
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
| | - Danielle Mignemi
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedics, Emory University School of Medicine (SAB, ALB, JTB), Atlanta, Georgia.,Emory Orthopaedics and Spine Center (DM), Atlanta, Georgia
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Yin L, Wu Y, Ren C, Wang Y, Fu T, Cheng X, Li R, Nie M, Mu Y. Treatment of acute achilles tendon rupture with the panda rope bridge technique. Injury 2018; 49:726-729. [PMID: 29361295 DOI: 10.1016/j.injury.2018.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/06/2018] [Accepted: 01/13/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described. METHODS Patient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively. RESULTS PBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6. CONCLUSION The PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation.
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Affiliation(s)
- Liangjun Yin
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yahong Wu
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changsong Ren
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yizhong Wang
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Fu
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangjun Cheng
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruidong Li
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mao Nie
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Mu
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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