Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair.
BACKGROUND
Surgical and nonsurgical treatments of Achilles tendon ruptures are available. Nonsurgical treatment using immobilization does not have the varying degrees of infection as seen with surgical procedures, but it frequently is linked to muscle atrophy, weakness, and higher rates of rerupture than surgical treatment. This study reports the results of 64 patients with Achilles tendon ruptures treated surgically and with early mobilization.


METHODS
Surgery of the ruptured tendon involved dividing the proximal stump into two separate strands and the distal stump into a single strand. The repair was advanced to a V-Y formation, and nonabsorbable sutures were used for repair. After wound closure, an early mobilization rehabilitation program was initiated, which consisted of wearing a moveable ankle brace for 4 to 6 weeks in 0 to 15 degrees of dorsiflexion and 10 weeks of regular exercises.


RESULTS
All 64 patients resumed normal activities in an average of 3.3 months regardless of whether the rupture was acute or chronic. Tendons healed with no reruptures. There were 13 complications, all wound infections, which healed when treated with antibiotics. The infection rate dropped markedly when wounds were inspected and dressings changed 1 week postoperatively, instead of at 2 weeks.


CONCLUSIONS
Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities. Applying tension to the tendon also improved strength of the calf muscles and improved ankle movement. The main concern with early mobilization is rerupture, but this was lessened by patients carefully following the weightbearing and early mobilization protocols. The results of this study strengthen the argument to employ early mobilization rehabilitation after surgical repair.
Sorrenti
Samiul J
SJ
North Sydney Orthopaedic And Sports Medicine Centre, Sydney, NSW, Australia. sorrenti@ozemail.com
D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome