Elongation of the Achilles Tendon After Rupture Repair Occurred Slightly Less with Postoperative Early Motion Than with Postoperative Immobilization

Abstract

Question: In patients having repair of Achilles tendon ruptures, does early motion or immobilization after surgery reduce Achilles tendon elongation? Design: Randomized (allocation concealed), unblinded, controlled trial with 60-week follow-up. Setting: A university hospital in Oulu, Finland. Patients: 50 patients who were 21 to 55 years of age (mean age 36 y, 92% men) and treated for an acute, complete, closed Achilles tendon rupture. Exclusion criteria included an age of >60 years, a delay in treatment of ≥1 week, systemic or local corticosteroid treatment, a previous Achilles tendon rupture on the contralateral side, and diabetes mellitus. Intervention: All patients had the same operative repair technique including a central gastrocnemius aponeurosis flap for repairing the Achilles tendon rupture. 25 patients were allocated to early motion and 25 to immobilization. On the first postoperative day, patients in the early-motion group received a below-the-knee, dorsal-blocking, rigid plaster splint, which they wore for 6 weeks. The splint allowed active free plantar flexion of the ankle with dorsiflexion restricted to neutral. Patients in the immobilization group received a below-the-knee plaster splint with the ankle held in a neutral position for 6 weeks. Full weight-bearing was permitted in both groups after 3 weeks. Patients were given a standard rehabilitation program of exercises to perform postoperatively. Jogging was begun at 12 weeks, and swimming and cycling exercises were recommended. Full-speed running and other sports were allowed at 6 months. Main outcome measures: Achilles tendon elongation (assessed by radiography) and functional outcomes (ankle performance and isokinetic calf-muscle strength scores). Main results: Achilles tendon elongation was less in the early motion group than in the immobilization group at a mean of 60 weeks (median, 2 vs 5 mm; p = 0.05 [borderline significance]). Ankle performance and isokinetic calf-muscle strength scores did not differ between groups. Conclusion: In patients who have had surgical repair of an Achilles tendon rupture, elongation of the Achilles tendon occurred slightly less after early motion than after immobilization.