Tendon lengthening similar with accelerated, traditional rehab after Achilles tendon repair
BOSTON — There was no significant difference in tendon length 12 weeks after Achilles tendon repair in patients who underwent accelerated rehabilitation compared with traditional rehabilitation, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting. However, patients who underwent accelerated rehabilitation had an increased amount of lengthening at 6 weeks postoperatively.
“[All] patients undergoing operative repair of Achilles tendon ruptures have significant lengthening after surgery,” Kelechi Okoroha, MD, told Healio.com/Orthopedics. “Our study found there was no difference in lengthening (repair site or intratendinous) at any time point between patients undergoing traditional vs. accelerated rehab protocols postoperatively. The finding that most of the lengthening occurs at the repair site suggests possible surgical implications to decrease lengthening although lengthening has not been shown to affect clinical outcome scores or ankle motion postoperatively.”
In a prospective, randomized controlled trial, Okoroha and colleagues assessed 20 patients who underwent primary repair of the Achilles tendon ruptures. Patients were assigned to undergo operative repair with either accelerated rehabilitation with graduated weight-bearing at 2 weeks or traditional rehabilitation with weight-bearing at 6 weeks. Immediately after surgery and at 12 weeks, investigators used CT scans to evaluate the 2-mm tantalum beads sutured to the Achilles tendon during repair. The difference in tendon repair site lengthening between the rehabilitation groups was the primary outcome.
Results showed that at 2 weeks postoperatively, all patients showed statistically significant lengthening. In patients who underwent accelerated rehab, there was a trend toward increased lengthening at 6 weeks postoperatively compared with patients who underwent traditional rehab (9.9 mm vs. 4.1 mm). At 12 weeks after surgery, the final amount of tendon lengthening was not significantly different between patients who underwent accelerated rehab vs. traditional rehab (14.4 mm vs. 13.4 mm, respectively).
“The results echo prior studies evaluating tendon lengthening in other procedures and suggest that a natural amount of lengthening occurs after any tendon repair and does not adversely affect outcomes,” he said. “It would be interesting to evaluate a larger cohort to see if patients were differentially affected by different amounts of lengthening postoperatively.” – by Monica Jaramillo
Okoroha K, et al. Abstract 78. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Okoroha reports no relevant financial disclosures.