Operative Treatment Of Achilles Tendon Ruptures Research Articles

Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials.

Achilles tendon rupture (ATR) is a significant injury that can require surgery and can have the risk of re-rupture even after successful treatment. Consequently, to minimize this risk, it is important to have a thorough understanding of the rehabilitation protocol and the impact of different rehabilitation approaches on preventing re-rupture. Two independent team members searched several databases (PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL) to identify randomized controlled trials (RCTs) on operative treatment of ATR. We included articles that covered open or minimally invasive surgery for ATR, with a detailed rehabilitation protocol and reports of re-rupture. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA Guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/C85, Supplemental Digital Content 2, http://links.lww.com/JS9/C86 and assessed using AMSTAR Tool, Supplemental Digital Content 3, http://links.lww.com/JS9/C87. A total of 43 RCTs were eligible for the meta-analysis, encompassing a combined cohort of 2553 patients. Overall, the postoperative incidence of ATR patients developing re-rupture was 3.15% (95% CI: 2.26-4.17; I2=44.48%). Early immobilization group patients who had ATR had a 4.07% (95% CI: 1.76-7.27; I2=51.20%) postoperative incidence of re-rupture; Early immobilization + active range of motion (AROM) group had an incidence of 5.95% (95% CI: 2.91-9.99; I2=0.00%); Early immobilization + weight-bearing group had an incidence of 3.49% (95% CI: 1.96-5.43; I2=20.06%); Early weight-bearing + AROM group had an incidence of 3.61% (95% CI: 1.00-7.73; I2= 64.60%); Accelerated rehabilitation (immobilization) group had an incidence of 2.18% (95% CI: 1.11-3.59; I2=21.56%); Accelerated rehabilitation (non-immobilization) group had a rate of 1.36% (95% CI: 0.12-3.90; I2=0.00%). Additionally, patients in the immediate AROM group had a postoperative re-rupture incidence of 3.92% (95% CI: 1.76-6.89; I2=33.24%); Non-immediate AROM group had an incidence of 2.45% (95% CI: 1.25-4.03; I2=22.09%). This meta-analysis suggests the use of accelerated rehabilitation intervention in early postoperative rehabilitation of the Achilles tendon. However, for early ankle joint mobilization, it is recommended to apply after one to two weeks of immobilization.

Commonly reported isokinetic parameters do not reveal long-term strength deficits of the Triceps surae complex following operative treatment of Achilles tendon rupture

Isokinetic strength assessments are common outcome measures following operatively treated Achilles tendon (AT) ruptures. However, there is a lack of clarity on whether commonly reported outcome measures (such as peak joint moment) are sufficient to describe the extent of long-term functional deficits following AT rupture and repair. The present study conducted a comprehensive isokinetic evaluation of the Triceps surae complex in 12 participants who previously underwent AT rupture and repair. Testing occurred 4.4 (±2.6) years following surgery, and consisted of maximal isokinetic strength assessments of the plantarflexors at two angular velocities (30 and 60°∙s−1) with the knee in flexed and straight positions. Differences between injured and non-injured limbs were tested through discrete and statistical parametric mapping analysis. Average joint moment showed significant main effects between injured and non-injured limbs, but common isokinetic parameters such as peak moment and angle of peak moment did not. The normalised moment curves showed a significant main effect of limb, angular velocity and knee joint position on joint moment throughout different portions of the range of motion. Temporal analysis revealed a significantly greater ability of the non-injured limb to sustain plantarflexor moments across a range of testing conditions. Participants who had undergone operative treatment of AT ruptures did not display inter-limb differences in discrete isokinetic strength outcomes that are often used in the literature. Instead, temporal analyses were required to highlight the reduced capacity of the injured limb to generate end-range joint moments and to sustain higher levels of joint moment for longer periods.