J Korean Foot Ankle Soc.  2023 Mar;27(1):12-16. 10.14193/jkfas.2023.27.1.12.

Simple Postoperative Exercise of Acute Achilles Tendon Rupture without Active Range of Motion Exercise

Affiliations
  • 1Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Abstract

Purpose
Postoperative exercise for acute Achilles tendon rupture is important for a patient’s return to daily life and sports. On the other hand, the protocol requires considerable effort to educate patients and continuous checking. This study evaluated the outcome of a new simple and delayed rehabilitation protocol after Achilles tendon rupture repair.
Materials and Methods
From July 2014 to November 2020, one hundred eighty-three patients were operated on by one surgeon. The exercise protocol was classified into two methods. One group (immediate protocol, control group) started immediate full weight bearing with a 20° plantar flexion range of motion from two days postoperatively. Ankle dorsiflexion was restricted to 0°. The other group (delayed protocol, case group) started full weight bearing with a controlled ankle motion boot from two weeks postoperatively. No range of motion exercise was allowed until six weeks postoperatively. Age, sex, body mass index, ankle range of motion, muscle power, time to return to previous physical activity, functional score, and complication rate were evaluated. The results of the two groups were compared using a Mann–Whitney test. Statistical significance was set as p<0.05.
Results
The range of motion, double heel rising, and one-leg standing were achieved faster in the control group (p<0.05). However, single-heel rising, repeated single-heel rising, return to previous activity (work, run, and sport), and functional scores showed no statistical difference (p>0.05).
Conclusion
Simple and delayed postoperative rehabilitation of acute Achilles tendon rupture without active range of motion exercises showed satisfactory functional results and a low complication rate.

Keyword

Achilles tendon rupture; Full weight bearing; Range of motion; Postoperative exercise

Figure

  • Figure. 1 Controlled ankle motion boot with range of motion (A), and without range of motion (B).

  • Figure. 2 Full squat was considered as dynamic full range of motion of ankle (A). Double heel rise exercise (B) and single heel rise exercise (C).


Reference

1. Suchak AA, Bostick G, Reid D, Blitz S, Jomha N. 2005; The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 26:932–6. doi: 10.1177/107110070502601106. DOI: 10.1177/107110070502601106. PMID: 16309606.
Article
2. Maempel JF, Clement ND, Wickramasinghe NR, Duckworth AD, Keating JF. Operative repair of acute Achilles tendon rupture does not give superior patient-reported outcomes to nonoperative management. Bone Joint J. 2020; 102-B:933–40. doi: 10.1302/0301-620X.102B7.BJJ-2019-0783.R3. DOI: 10.1302/0301-620X.102B7.BJJ-2019-0783.R3. PMID: 32600149.
Article
3. Gould HP, Bano JM, Akman JL, Fillar AL. 2021; Postoperative rehabilitation following achilles tendon repair: a systematic review. Sports Med Arthrosc Rev. 29:130–45. doi: 10.1097/JSA.0000000000000309. DOI: 10.1097/JSA.0000000000000309. PMID: 33972490.
Article
4. McCormack R, Bovard J. 2015; Early functional rehabilitation or cast immobilisation for the postoperative management of acute Achilles tendon rupture? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 49:1329–35. doi: 10.1136/bjsports-2015-094935. DOI: 10.1136/bjsports-2015-094935. PMID: 26281836.
Article
5. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. 2017; Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? Arch Orthop Trauma Surg. 137:333–40. doi: 10.1007/s00402-017-2627-9. DOI: 10.1007/s00402-017-2627-9. PMID: 28097423.
Article
6. Kim U, Choi YS, Jang GC, Choi YR. 2017; Early rehabilitation after open repair for patients with a rupture of the Achilles tendon. Injury. 48:1710–3. doi: 10.1016/j.injury.2017.04.050. DOI: 10.1016/j.injury.2017.04.050. PMID: 28465006.
Article
7. Okoroha KR, Ussef N, Jildeh TR, Khalil LS, Hasan L, Bench C, et al. 2020; Comparison of tendon lengthening with traditional versus accelerated rehabilitation after Achilles tendon repair: a prospective randomized controlled trial. Am J Sports Med. 48:1720–6. doi: 10.1177/0363546520909389. DOI: 10.1177/0363546520909389. PMID: 32203675.
Article
8. Röell AE, Timmers TK, van der Ven DJC, van Olden GDJ. 2021; Rehabilitation after surgical repair of acute Achilles tendon rupture: functional outcome with a minimum follow-up of 6 months. J Foot Ankle Surg. 60:482–8. doi: 10.1053/j.jfas.2020.09.003. DOI: 10.1053/j.jfas.2020.09.003. PMID: 33546991.
Article
9. Valkering KP, Aufwerber S, Ranuccio F, Lunini E, Edman G, Ackermann PW. 2017; Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 25:1807–16. doi: 10.1007/s00167-016-4270-3. DOI: 10.1007/s00167-016-4270-3. PMID: 27539402. PMCID: PMC5487693.
Article
10. Won Lee K, Bae JY, Ho BC, Kim JH, Seo DK. 2022; Immediate weightbearing and ankle motion exercise after acute Achilles tendon rupture repair. J Foot Ankle Surg. 61:604–8. doi: 10.1053/j.jfas.2021.10.021. DOI: 10.1053/j.jfas.2021.10.021. PMID: 34785129.
Article
11. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. 2012; Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 94:2136–43. doi: 10.2106/JBJS.K.00917. DOI: 10.2106/JBJS.K.00917. PMID: 23224384. PMCID: PMC3509775.
12. Movin T, Ryberg A, McBride DJ, Maffulli N. 2005; Acute rupture of the Achilles tendon. Foot Ankle Clin. 10:331–56. doi: 10.1016/j.fcl.2005.01.003. DOI: 10.1016/j.fcl.2005.01.003. PMID: 15922923.
Article
13. Longo UG, Rittweger J, Garau G, Radonic B, Gutwasser C, Gilliver SF, et al. 2009; No influence of age, gender, weight, height, and impact profile in achilles tendinopathy in masters track and field athletes. Am J Sports Med. 37:1400–5. doi: 10.1177/0363546509332250. DOI: 10.1177/0363546509332250. PMID: 19329789.
Article
14. Notarnicola A, Maccagnano G, Di Leo M, Tafuri S, Moretti B. 2014; Overload and neovascularization of Achilles tendons in young artistic and rhythmic gymnasts compared with controls: an observational study. Musculoskelet Surg. 98:115–20. doi: 10.1007/s12306-013-0275-y. DOI: 10.1007/s12306-013-0275-y. PMID: 23716192.
Article
15. Inglis AE, Scott WN, Sculco TP, Patterson AH. 1976; Ruptures of the tendo achillis. An objective assessment of surgical and non-surgical treatment. J Bone Joint Surg Am. 58:990–3. DOI: 10.2106/00004623-197658070-00015. PMID: 977631.
Article
16. Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. 1978; Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 6:107–11. doi: 10.1177/036354657800600302. DOI: 10.1177/036354657800600302. PMID: 655329.
Article
17. Maxwell LC, Enwemeka CS. 1992; Immobilization-induced muscle atrophy is not reversed by lengthening the muscle. Anat Rec. 234:55–61. doi: 10.1002/ar.1092340107. DOI: 10.1002/ar.1092340107. PMID: 1416097.
Article
18. Rantanen J, Hurme T, Kalimo H. 1999; Calf muscle atrophy and Achilles tendon healing following experimental tendon division and surgery in rats. Comparison of postoperative immobilization of the muscle-tendon complex in relaxed and tensioned positions. Scand J Med Sci Sports. 9:57–61. doi: 10.1111/j.1600-0838.1999.tb00208.x. DOI: 10.1111/j.1600-0838.1999.tb00208.x. PMID: 9974199.
Article
19. Liu X, Dai TJ, Li BL, Li C, Zheng ZY, Liu Y. Early functional rehabilitation compared with traditional immobilization for acute Achilles tendon ruptures: a meta-analysis. Bone Joint J. 2021; 103-B:1021–30. doi: 10.1302/0301-620X.103B6.BJJ-2020-1890.R1. DOI: 10.1302/0301-620X.103B6.BJJ-2020-1890.R1. PMID: 34058871.
20. Mosconi M, Pasta G, Annunziata S, Guerrieri V, Ghiara M, Perelli S, et al. 2022; Fast functional rehabilitation protocol versus plaster cast immobilization protocol after Achilles tendon tenorrhaphy: is it different? Clinical, ultrasonographic, and elastographic comparison. Diagnostics (Basel). 12:1824. doi: 10.3390/diagnostics12081824. DOI: 10.3390/diagnostics12081824. PMID: 36010175. PMCID: PMC9406849.
Article
Full Text Links
  • JKFAS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr