Achilles Tendon Rupture
Conditions
Keywords
Achilles tendon rupture, Open surgical repair, Early functional mobilization, Weightbearing, Rehabilitation
Brief summary
The purpose of this study was to determine the effect of protected early weightbearing (PEWB) compared to non-weightbearing (NWB) after surgery for an Achilles tendon rupture (ATR) on health related quality of life (HRQL) in the initial six week period after surgery, functional recovery over time, return to work and activity and complications. We hypothesized that PEWB following ATR repair would result in: i) improved HRQL in the initial postoperative period, ii), a quicker recovery of HRQL, strength and endurance, iii) earlier return to work and sport, and iv) no increase in complications, such as re-rupture compared to NWB.
Detailed description
Achilles tendon rupture (ATR) is commonly treated with open surgical repair. Following surgical repair, there are a variety of protocols, ranging from complete immobilization to immediate postoperative mobilization with early weightbearing. However, no clear consensus regarding the optimal postoperative rehabilitation protocol for ATRs exists. Early rehabilitation after ATR has been shown to be beneficial in animal and human studies. Human prospective studies and randomized controlled trials have shown that early postoperative mobilization do not pose additional risks compared to cast immobilization, with a trend toward a reduction in lost work days and an earlier return to sport. However, these trials define early postoperative mobilization differently (i.e. use different combinations of weightbearing and range of motion). This makes it difficult to determine which factor in the early rehabilitation process plays an important role in optimizing recovery. An important component of early rehabilitation is weightbearing. Comparison: Patients weightbearing in the early rehabilitation period after surgical repair of the Achilles tendon compared to patients non-weightbearing after the surgical repair of the Achilles tendon repair. With the exception of weightbearing status, both groups performed the same rehabilitation program.
Interventions
PROCEDUREProtected early weightbearing/Achilles tendon surgery
Sponsors
Royal Alexandra Hospital
Edmonton Orthopaedic Research Society
DonJoy Orthotics
University of Alberta
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* closed and complete Achilles tendon rupture * seen within 14 days of injury in hospital
Exclusion criteria
* unwilling to follow the study's rehabilitation protocol * unable to speak or read English * co-morbid conditions such as diabetes and neurological or collagen disease * pregnancy * recent immunosuppressant or fluoroquinolone therapy * previous Achilles tendon symptoms * previous ipsilateral rupture * sustained an additional injury not allowing weightbearing * an Achilles tendon avulsion injury * unfit for surgery
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Health related quality of life: Short form 36 questionnaire | six weeks |
Secondary
| Measure | Time frame |
|---|---|
| Level of activity: tailored question | six weeks, 3 months, and 6 months |
| Major complications: chart review | 6 weeks, 3 months, and 6 months |
| Minor complications: chart review | 6 weeks, 3 months, and 6 months |
| Isometric muscle strength: hand held myometer | 6 weeks, 3 months, and 6 months |
| Health related quality of life: Short Form-36 questionnaire | 3 and 6 months |
| Calf circumference: standardized tape measurement | 6 weeks, 3 months, and 6 months |
| Return to work/sport: tailored question | 6 weeks, 3 months, and 6 months |
| Physiotherapy utilization: tailored question | 6 weeks, 3 months, and 6 months |
| Muscle endurance: heel raise counting device | 6 months |
Countries
Canada
Outcome results
None listed