Immediate Full Weight-Bearing Mobilization Was Better Than Immobilization After Operative Repair of a Ruptured Achilles Tendon

Background: Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. Methods: We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. Results: Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. Conclusion: The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. Level of Evidence: Level IV, retrospective case series.

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One-Step Approach for Infections After Achilles Tendon Open Repair: The Distally Based Peroneus Brevis Muscle Flap

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620951540 ◽

2020 ◽

pp. 153473462095154

Author(s):

Luca Vaienti ◽

Giuseppe Cottone ◽

Giovanna Zaccaria ◽

Emanuele Rampino Cordaro ◽

Francesco Amendola

Keyword(s):

Achilles Tendon ◽

Median Time ◽

Tendon Rupture ◽

Open Repair ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Muscle Flap ◽

Full Weight Bearing ◽

Peroneus Brevis ◽

Distally Based

The aim of this single-center, retrospective study is to demonstrate the effectiveness of distally based peroneus brevis muscle flap as first therapeutic option for infections after Achilles tendon open repair. We retrospectively analyzed 14 consecutive patients with complete Achilles tendon rupture and developing surgical site infection after an attempt of open surgical repair. Every patient was reconstructed with distally base peroneus brevis muscle flap. The primary outcome was the return to work and the initiation of full weight-bearing. Secondary outcomes were complication rate and time needed to return to work. A review of the literature was conducted to better define the actual standard treatment. Each patient returned to work. No flap necrosis occurred. Two minor healing delays and one hematoma were reported. Median time to wound healing was 17 days (interquartile range [IQR] = 13-20). Median time to full weight-bearing was 52 days (IQR = 47-55). Median follow-up (FU) was 21 months. Distally based peroneus brevis flap is a safe treatment for surgical site infections after Achilles tendon rupture repair. Patients regained full weight-bearing after a median time of 52 days from the surgical reconstruction. No major complications were observed. This flap clearly emerges as first reconstructive option for complications after surgery of Achilles tendon region.

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Rehabilitation after percutaneous Achilles tendon rupture: The effect of full-weight bearing

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.022 ◽

2016 ◽

Vol 22 (2) ◽

pp. 14-15

Author(s):

S. Tsitsilonis ◽

T. Gehlen ◽

A. Agres ◽

Benjamin Bartek ◽

G. Duda ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Full Weight Bearing

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Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000769 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000769

Author(s):

Håkan Alfredson ◽

Christoph Spang

Keyword(s):

Achilles Tendon ◽

Weight Bearing ◽

Case Series ◽

Achilles Tendinopathy ◽

Full Weight Bearing ◽

Bone Pathology ◽

Level Of Evidence ◽

Pain Mechanisms ◽

Painful Condition ◽

Insertional Achilles Tendinopathy

BackgroundInsertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.MethodsEleven patients (eight men and three women) with a mean age of 44 years (range 24–62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.ResultsAt follow-up 21 (median, range 12–108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0–52) to 91 (range 33–100) (p<0.01).ConclusionIn patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.Level of evidenceIV Case series.

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Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft

Video Journal of Sports Medicine ◽

10.1177/26350254211021859 ◽

2021 ◽

Vol 1 (5) ◽

pp. 263502542110218

Author(s):

Michael R. Carmont ◽

Arunansu Saha ◽

John-Henry Rhind ◽

Niklas Nilsson ◽

Jón Karlsson ◽

...

Keyword(s):

Achilles Tendon ◽

Plantar Flexion ◽

Weight Bearing ◽

Metatarsophalangeal Joint ◽

Full Weight Bearing ◽

First Metatarsophalangeal Joint ◽

Screw Insertion ◽

Graft Harvest ◽

Open Reconstruction ◽

Semitendinosus Graft

Background: Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function. Indications: The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap. Technique Description: The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion. Discussion/Conclusion: Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.

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Comparison of Tendon Lengthening with Traditional vs. Accelerated Rehab Following Achilles Tendon Repair: A Randomized Controlled Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00323 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0032

Author(s):

Kelechi Okoroha ◽

Najib Ussef ◽

Erik Eller ◽

Ferras Zeni ◽

Vasilios Moutzouros

Keyword(s):

Randomized Controlled Trial ◽

Achilles Tendon ◽

Controlled Trial ◽

Weight Bearing ◽

X Rays ◽

Repair Site ◽

Operative Repair ◽

Randomized Controlled ◽

Tendon Lengthening ◽

Tendon Ruptures

Objectives: Operative repair of Achilles tendon ruptures have shown successful outcomes. However, little is know about the amount of tendon or repair site lengthening after repair and if lengthening is affected by rehab protocols. The purpose of our study was to compare lengthening of the Achilles tendon after surgical repair, comparing traditional and accelerated rehab protocols. Methods: Twenty patients undergoing primary repair of Achilles tendon ruptures were assessed for participation. We performed a prospective randomized controlled trial in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The study arms included operative repair of Achilles tendon rupture with either accelerated (graduated weight bearing at 2 weeks) or traditional rehab (weight bearing at 6 weeks). During repair, two 2-mm tantalum beads with laser-etched holes were sutured to the Achilles tendon at the repair site. Beads were evaluated via CT scans immediately post-operatively and at 12 weeks. X-rays were obtained at time 0 and then at 2, 6, and 12 weeks. The primary outcome of the study was the difference in tendon or repair site lengthening between the study arms. Randomization was by a computerized algorithm. The observer was blinded and the patient was not blinded to the intervention. Results: Zero patients declined participation and all 20 patients were included for final analysis. All patients showed statistically significant lengthening at two weeks following surgery. There was a trend toward increased lengthening at 6 weeks in the accelerated rehab group (9.9 mm, range 2.6 -13.9 mm) compared to the traditional rehab group (4.1 mm, range 1.5 -9.0 mm), although this was not statistically significant; p = .07. However the final amount of tendon lengthening at 12 weeks after surgery was not different between the accelerated rehab group (14.4 mm, range 11.7 -17.0 mm) and the traditional rehab group (13.4 mm, range 10.7 -17.0 mm); p = .38. Conclusion: This study’s findings suggest that all patients undergoing operative repair of Achilles tendon ruptures have significant lengthening after surgery. Although there was a trend toward increased lengthening at 6 weeks in the accelerated rehab group, there was no difference in tendon lengthening at final follow up between the two groups.

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FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

Medicinos teorija ir praktika ◽

10.15591/mtp.2015.100 ◽

2015 ◽

Vol 21 (4.1) ◽

pp. 638-642

Author(s):

Andrius Brazaitis ◽

Algirdas Tamosiunas ◽

Janina Tutkuviene

Keyword(s):

Patellar Instability ◽

Weight Bearing ◽

Patellofemoral Pain ◽

Full Weight Bearing ◽

Trochlear Groove ◽

Patellar Tilt ◽

Full Extension ◽

Low Degrees ◽

Mri Study ◽

Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

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Immediate weight bearing and function following surgery for neglected Achilles tendon ruptures

10.26226/morressier.570fc33ed462b8029237ef1f ◽

2016 ◽

Author(s):

ADRIANA AVILA

Keyword(s):

Achilles Tendon ◽

Weight Bearing ◽

Tendon Ruptures ◽

And Function

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Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03913-0 ◽

2021 ◽

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Matthias Meyer ◽

Günther Maderbacher ◽

Jan Reinhard ◽

...

Keyword(s):

Risk Factors ◽

Enhanced Recovery ◽

Weight Bearing ◽

Femoral Stem ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Fill Ratio ◽

Stem Subsidence ◽

Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

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