Rehabilitation Programs After Achilles Tendon Rupture

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior., Conselho Nacional de Desenvolvimento Científico e Tecnológico

The purpose of this study is to evaluate the effects of early mobilization versus traditional immobilization rehabilitation programs after surgical Achilles tendon repair on the mechanical (torque-angle and torque-velocity relationships) and electrical (neuromuscular activation) properties of the plantar- and dorsiflexor muscles, gastrocnemius medialis morphology (muscle architecture), functional performance, and the mechanical and material properties (force-elongation and stress-strain relationships) of the injured and uninjured Achilles tendon. The hypothesis is that the early mobilization could reduce the deleterious effects of the joint immobilization and improve the tendon healing.

Participants were allocated into one of two intervention groups (traditional immobilization or early mobilization). Traditional immobilization group (45 days of plaster cast immobilization; after the immobilization period, subjects received instructions on how to perform a home-based exercise program) Early mobilization (six weeks of physical therapy program; three times per week; one to two hours of exercises for regaining range of motion and muscular endurance) Control group (subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized.

Achilles tendon rupture, Rehabilitation, Immobilization, Muscle architecture, Functionality, Neuromuscular parameters, Weight-Bearing

45 days of plaster cast immobilization After the immobilization period, subjects received instructions on how to perform a home-based exercise program

Subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized.

After surgery subjects were immobilized in a plaster cast, with the ankle positioned in gravitational equinus; weight bearing was not allowed. Two weeks post-operatively, the cast was removed and the patient was immobilized with a new plaster cast, with the ankle in the same position. Four weeks post-operatively, the ankle was plastered in neutral position (i.e. with the sole of the foot perpendicular to the shank), and weight bearing was encouraged. Six weeks post-operatively, the plaster cast was removed The home exercise program consisted of active exercises and stretches to improve ankle range of motion, and resistance and balance exercises

The physical therapy started two weeks after the surgery and lasted six weeks, during which a removable brace was used. Therapy sessions, three times per week in the six-week period, included one to two hours of exercises for regaining range of motion and muscular endurance.

Torque was measured 3 times during the study: three, six and more than 12 months after surgical repair.

Muscular architecture (muscle thickness, pennation angle and fascicle length) was assessed by ultrasonography

Muscle architecture was measured 4 times during the study: 45 days, three, six and more than 12 months after surgical repair.

Muscular electrical activation was measured 3 times during the study: three, six and more than 12 months after surgical repair

Tendon mechanical and material properties were assessed by Achilles tendon elongation (measured by ultrasound) during isometric plantar flexion ramp contraction as a function of ankle joint torque.

Tendon mechanical and material properties were measured 3 times during the study: three, six and more than 12 months after surgical repair.

Functional performance was assessed by functional tests (standing heel-rise, time up and go and jump tests) and AOFAS questionnaire.

Functional performace was measured 3 times during the study: three, six and more than 12 months after surgical repair

Inclusion Criteria: Male Achilles tendon rupture Exclusion Criteria: arterial insufficiency diabetes autoimmune disease patients who used systemic antibiotics or steroids or showed any other clinical contraindication to perform maximum voluntary contractions on a dynamometer.