NON-SURGICAL TREATMENT OF ACHILLES TENDON: SCOPE OF ISOKINETIC SYSTEMS IN EARLY FUNCTIONAL REHABILITATION 1211

Abstract

Method: n=31 Mean age: 43 years (range: 18-73 years) Inclusion criteria for non-surgical treatment • Sonographically verified diastasis of the ruptured ends of the tendon, size of the diastasis <0.5 cm at 20° plantar flexion; • consent of the patient, • below-knee plaster, 20° plantar flexion for one week; • wearing a vario stabil shoe for 6 weeks, with an instep raiser for elevation of the heel; elevation of the heel should be as follows: 3 cm up to the 4th week (during the first four weeks the shoe should be worn at night too) and thereafter 2 cm up to the 6th week and 1 cm up to the 8th week (only during the day); • continuous passive movement of the isokinetic system (Biodex Joint System II) beginning in the 3rd post-traumatic week, consisting of free plantar flexion, limited dorsal extension and successive distension to 0° in 2 weeks, 2 × daily for 25 minutes; • active concentric eccentric training from the fourth week onward with a gradual increase in resistance, 2 × daily for 30 minutes; • using further rehabilitation measures from the 5th week onward - riding a bicycle with the vario stabil, underwater therapeutic exercise and proprioceptive training up to the 12th week. Results: Isokinetic tests performed 3 months after injury Difference between sides: 60°/s eccentric - 13.1 ± 11.5%, 60°/s concentric 22.4 ± 8.6%, 180°/s concentric 41.0 ± 13.3% Follow-up period: 1,5 years after injury Holz score: good result - 80%, satisfactory result - 20%, unsatisfactory result - 0% Achilles tendon reflex: of same quality on both sides - 60%, not obtainable- 13% Isokinetic systems offer various possibilities of application in early functional rehabilitation, and the subsequent results of treatment can be objectified by using isokinetic tests.