BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT

Immediate full-weight-bearing mobilization for repaired Achilles tendon ruptures: A pilot study

By M.L. Costa, L. Shepstone, C. Darrah, T. Marshall, & S.T. Donell

Reprinted with permission from Injury, Int. J. Care Injured, 34 (2003), 874-876

Abstract
Recent experimental and clinical evidence suggests that early loading and mobilization for Achilles tendon ruptures may improve functional outcomes. This paper presents the results of a pilot study designed to assess the safety of immediate weight-bearing mobilization. Twenty-eight operatively repaired patients were randomized to either immediate loading in an orthosis or traditional plaster casting. An independent observer, blinded to treatment, assessed the results. Improved clinical, anthropometric and functional outcomes were noted in the immediate loading group. Ultrasound assessment confirmed no deleterious effects upon the tenodesis. There was one re-rupture of the tendon at a minimum follow-up of one year.

Introduction

Rupture of the Achilles tendon is a serious and disabling condition. Current epidemiological data suggests an incidence of 18 per 100,000 per year (Leppilahti, & Orava, 1998). This incidence is increasing (Maffuli, 1999). The condition typically affects young active adults and is associated with prolonged periods of work and much longer abstinence from sporting activity (Cetti, Christensen, Ejsted, Jenses, & Jorgensen, 1993). This has significant financial and health implications.

Experimental models suggest that early loading of the ruptured Achilles tendon prevents detrimental alterations in muscle characteristics and favourably influences maturation of collagen fibres within the tendon (Rantanen, Hurme, & Kalimo, 1999; Qin, Appell, Chan, & Maffulli, 1997). Early mobilization and delayed loading have also been advocated by a small number of clinical studies (Saw, Baltzopoulos, Lim, Rostron, Bolton-Maggs, & Calver, 1993; Roberts, Palmer, Vince, & Deliss, 2001; Saleh, Marshall, Senior, & MacFarlane, 1992). These papers suggest improved functional outcomes. However, none of the studies has used immediate weight-bearing mobilization and movement. In general, adoption of the principle of early loading and mobilization has been extremely slow. This may be due to the potential risks of re-rupture or tendon lengthening with early activity. The expense of previous custom-made orthoses may also have contributed.

The aim of this pilot study was to test the safety of immediate full weight-bearing mobilization following operative repair of the rupture Achilles tendon.

This abstract is a portion of the article which appears in the Spring 2005 issue of BodyCast.  
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