title: Early controlled tension improves the material properties of healing human achilles tendons after ruptures: a randomized trial.
abstract: BACKGROUND
  Weightbearing in a fixed brace after acute Achilles tendon ruptures does not necessarily lead to mechanical tension in the tendon. Early motion has a positive effect on the clinical outcome, but it is not clear if this is because of effects on tendon strength or unspecific effects. The aim of this study was to examine if tensional loading leads to an improvement in the mechanical properties of the healing Achilles tendon.
  
  
  OBJECTIVE
  The elastic modulus of the tendon callus is increased by early tensional loading.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  Thirty-five patients with an acute Achilles tendon rupture were recruited consecutively. They underwent surgery with a single suture and received metal markers in the distal and proximal parts of the tendon. After surgery, the patients were randomized to either cast immobilization for 7 weeks or tensional loading. The latter group wore a cast for 2 weeks and then a removable foam walker boot for 5 weeks. They were instructed to remove the boot twice daily and push a special training pedal to produce a predetermined, gradually increasing tensional load on the healing tendon. At 7, 19, and 52 weeks postoperatively, the patients were investigated with roentgen stereophotogrammetric analysis under different loading conditions and computed tomography. The collected data allowed calculation of the modulus of elasticity. At 52 weeks, the clinical outcome was also examined using the Achilles tendon Total Rupture Score (ATRS) and the heel-raise index.
  
  
  RESULTS
  The elastic modulus at 19 and 52 weeks was higher in the tensional loading group. There was no significant difference in the ATRS or heel-raise index at 52 weeks. As in previous studies, there was a significant correlation between the modulus at 7 weeks and the heel-raise index at 52 weeks. There were no signs of tendon elongation.
  
  
  CONCLUSIONS
  Early tensional loading improves the mechanical properties of the healing Achilles tendon.
authors.affiliation: Thorsten Schepull, Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE 58185 Linköping, Sweden. thorsten.schepull@lio.se; Per.aspenberg@liu.se.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schepull
authors.forename: Per
authors.initials: P
authors.lastname: Aspenberg
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000502:physiology; D000328:Adult; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function; D013708:Tendon Injuries / Q000534:rehabilitation*
keywords: Achilles tendon; loading; modulus of elasticity; rupture; weightbearing