Immediate weight bearing & ankle exercise after repair of Achilles tendon tied to low re-rupture rate

GangNeung-si, South Korea: Dr K. Won Lee et al found in a retrospective study that - immediate full weight bearing and ankle motion exercise after repair of acute Achilles tendon rupture can be a good rehabilitation option with a low re-rupture rate and satisfactory functional result.

The incidence of Achilles tendon rupture is increasing. Postoperative rehabilitation after repairing acute Achilles tendon rupture is very important because the choice of treatment during the rehabilitation period can influence the results. Moreover, the method of functional rehabilitation varies and is developing steadily. Recent studies recommend a functional rehabilitation protocol, and this approach is accepted widely.

All patients were managed with the same method. Until postoperative day (POD) 1, patients stayed on the bed, and non-weight bearing walk using the crutch was allowed.

At POD 2, the posterior splint was removed, and ROM walker (Ossur, USA) was applied from neutral to 20° plantar flexion.

The patients were all discharged at POD 2. Subsequently, tolerable full weight bearing walk was allowed.

Rehabilitation exercise was initiated from POD 1. Patients who were afraid of full weight bearing could use crutches.

Stitch out was performed at POD 2 weeks at the out-patient department, and tendon continuity was checked using the Thompson-squeezing test. The patients were encouraged to walk without crutches for full weight bearing.

The ROM walker was removed at POD 4 weeks, and tolerable full weight bearing walk was allowed with ordinary shoes.

Patients were followed every month to check ankle flexibility and leg.

From July 2014 to July 2016, 67 patients underwent surgery for acute Achilles tendon rupture by one surgeon. Age, sex, body mass index, injury mechanism, rehabilitation method and progress, time to return to previous physical activity, and complications were evaluated.

The observations in the study were-

• The mean time to be able to squat fully was 10 +/- 4.7 (4-20) weeks. Full squatting was possible in 92.8% (52 patients).

• The mean time to perform a single-limb heel rise and repetitive single-limb heel rise was 12.6 +/- 3.9 (6-24) and 23.3 +/- 7.7 (8-40) weeks, respectively.

• The mean time to return to sports was 20.6 +/- 5.2 (12-32) weeks.

• The major complication rate was 3.5% (one re-rupture and one tendon elongation).

• The mean pre- and postoperative Achilles Tendon Total Rupture Score was 29.5 +/- 3.7 (20-38) and 79.3 +/- 18.5 (20-98) points, respectively. The increase was significant (p < .01).

• The major complication rate was 3.5% (one re-rupture and one tendon elongation). Minor complications and partial rupture were reported in 14.2% (8 patients) and 5.3% of patients (3 patients), respectively.

Further reading:

Immediate Weight bearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair

The Journal of Foot & Ankle Surgery 61 (2022) 604−608

https://doi.org/10.1053/j.jfas.2021.10.021