Title: Randomized Controlled Trials of Immediate Weight-Bearing Mobilization for Rupture of the Tendo Achilles
Authors: M.L. Costa, et al
Source: JBJS (British). 2006, 88: 69-77.
PODIATRIC RELEVANCE:
Re-rupture as well as muscle atrophy after Achilles tendon rupture are a concern. There are benefits of early mobilization of acute Achilles tendon ruptures. Experiments suggest early loading prevents muscle alteration and promotes maturation of collagen. These authors investigated immediate loading in patients treated operatively and non-operatively.
METHODS:
Two independent randomized controlled trials were performed at 3 centers on patients who sustained acute Achilles tendon ruptures. The first examined 48 patients treated operatively with end to end repair randomized into 2 groups. The treatment group was managed post-operatively with immediate mobilization in orthosis including three 1.5 cm heel rises. The non-treatment group was immobilized in a cast. The second involved 48 patients treated non-operatively. One group was allowed immediate weight-bearing in the same manner and the other was immobilized. Every patient was placed in equinus which was unchanged for the first 6 weeks then reduced at 2 weekly intervals. The primary outcome measured was time taken to return to normal activities. Other factors evaluated included time to return to sports, walking or climbing stairs. Each patient answered a EuroQol questionnaire. At 6 months, a blinded independent physiotherapist clinically assessed calf function and ankle dorsiflexion.
RESULTS:
There was significant difference between the groups. In the mobilized group, it took 12.5 weeks to return to walking and 13 weeks to climbing stairs. In the immobilized group, it was 18 weeks to walking and 22 weeks to climbing stairs. There wasn’t a difference in time to return to sports or clinical variables. In the treatment group, there were 2 re-ruptures. In the non-operative trial, there wasn’t a difference in time to walking, climbing stairs or clinical variables. There was one re-rupture. The questionnaire reported maximal functional deficit 2 weeks after treatment completion. All returned to pre-injury state at 6 months.
COMMENTS:
Acute Achilles tendon ruptures can be immediately loaded without increasing complication rate. This study failed to prove any evidence of tendon over-lengthening or a higher re-rupture rate.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.