SLR - April 2021 - Mohammed A. Yousuf

Does Early Functional Mobilization Affect Long-Term Outcomes after an Achilles Tendon Rupture? A Randomized Clinical Trial

Reference: Aufwerber S, Heijne A, Edman G, Silbernagel KG, Ackermann PW. Does Early Functional Mobilization Affect Long-Term Outcomes After an Achilles Tendon Rupture? A Randomized Clinical Trial. Orthop J Sports Med. 2020;8(3):2325967120906522. Published 2020 Mar 16. doi:10.1177/2325967120906522

Level of Evidence: Level I

Scientific Literature Review

Reviewed By: Mohammed A. Yousuf, DPM
Residency Program: New York Presbyterian-Queens – Flushing NY

Podiatric Relevance: Achilles tendon ruptures are widely treated by podiatric physicians and orthopedists. The treatment for these injuries continues to be a controversial topic of debate with no definitive post-operative treatment protocol widely accepted. Prolonged immobilization and slow transitions to weight bearing has been shown to be detrimental to patient recovery following surgical repair. The aim of this study was to assess if early functional mobilization (EFM) and early loading could improve patient functional outcomes following surgical repair in patient’s with acute Achilles tendon ruptures.

Methods: This was a prospective randomized controlled study of 135 patients with acute achilles ruptures who were selected to participate from a pool of 311 candidates between December 2013 to February 2018 at both Karoliniska University Hospital and Danderyd Hospital in Stockholm. The patients, 114 men and 36 women, all underwent an achilles repair using a modified Kessler approach and were then randomized into two groups, a control group and an intervention group. Those in the intervention group were instructed to perform early functional mobilization immediately following the repair, were given an adjustable orthosis device, and were permitted to immediately weightbear. The control group underwent two weeks of non-weightbearing in a below the knee cast and then transitioned to weightbearing in an ankle orthosis device. Ankle orthosis device were discontinued at six weeks and both groups transitioned to normal shoes with heel lifts for the following four weeks. Five questionnaire were sent to patients at six and twelve months, achilles tendon total rupture score (ATRS), Physical Activity Scale, RAND 36 Item Health Survey for assessing general health and vitality, The Foot and Ankle Outcome Score (FAOS) and the Tampa Scale of Kinesiophobia. Follow up visits at six and twelve months were used to evaluate patients functional outcomes and were all performed by one physical therapist.

Results: The EFM group at six months had higher ATRS mean values compared to the control group, 65.1 ± 19.2 to 59.1 ± 21.4 respectively. EFM group at six months demonstrated higher RAND-36 subscales for general health and vitality (P <.05). The two groups demonstrated improvements in both function and pain at six months and twelve months with P< .05. When assessing for DVT incidence there was no significant statistical difference noted; P > .05. No difference was noted at six months or twelve months between the two groups with heel rise test or jump tests; P >0.05. 

Conclusions: Weightbearing immediately postoperatively with early functional mobility was shown to have marginally improved general health and vitality at six months, but demonstrates no differences between the groups as it relates to heel rise tests or jump tests.

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