TY - JOUR

T1 - Tendon Elongation and Function After Delayed or Standard Loading of Surgically Repaired Achilles Tendon Ruptures

T2 - A Randomized Controlled Trial

AU - Hoeffner, Rikke

AU - Agergaard, Anne Sofie

AU - Svensson, Rene B.

AU - Cullum, Camilla

AU - Mikkelsen, Rasmus Kramer

AU - Konradsen, Lars

AU - Krogsgaard, Michael

AU - Boesen, Mikael

AU - Kjaer, Michael

AU - Magnusson, S. Peter

N1 - Publisher Copyright: © 2024 The Author(s).

PY - 2024

Y1 - 2024

N2 - Background: Achilles tendon ruptures often result in long-term functional deficits despite accelerated (standard) rehabilitation. Purpose/Hypothesis: The purpose of this study was to investigate if delayed loading would influence functional, clinical, and structural outcomes of the muscles and tendon 1 year after a surgical repair. It was hypothesized that delaying the loading would reduce the heel-rise height deficit 1 year after Achilles tendon rupture. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In total, 48 patients with a surgically repaired Achilles tendon rupture were randomized to 2 groups: the standard group received the currently accepted rehabilitation, and the delayed group received the same rehabilitation except that initial loading was delayed by 6 weeks. The primary outcome was the heel-rise height difference between the injured and uninjured sides at 1 year. The secondary outcomes were (1) tendon length measured with magnetic resonance imaging, (2) muscle fascicle length and pennation angle of the gastrocnemius medialis muscle, (3) Doppler activity measured with ultrasonography, (4) Achilles tendon Total Rupture Score (ATRS), and (5) isometric muscle strength. Results: The mean heel-rise height deficits for the standard and delayed groups were −2.2 cm and −2.1 cm, respectively (P =.719). The soleus part of the tendon was already elongated 1 week after surgery in both groups without a between-group difference (side-to-side difference: standard, 16.3 mm; delayed, 17.5 mm; P =.997) and did not change over 52 weeks. The gastrocnemius tendon length was unchanged at 1 week but elongated over time without a between-group difference (side-to-side difference at 52 weeks: standard, 10.5 mm; delayed, 13.0 mm; P =.899). The delayed group had less Doppler activity at 12 weeks (P =.006) and a better ATRS (standard, 60 points; delayed, 72 points; P =.032) at 52 weeks. Conclusion: Delayed loading was not superior to standard loading in reducing the heel-rise height difference at 1 year. The data indirectly suggested reduced inflammation in the initial months and a better patient-reported outcome at 1 year in the delayed group. The soleus part of the tendon was already markedly elongated (35%) 1 week after surgery, while the length of the gastrocnemius tendon was unchanged at 1 week but was 6% elongated at 1 year. Together, these data indirectly suggest that the delayed group fared better, although this finding needs to be confirmed in future investigations. Registration: NCT04263493 (ClinicalTrials.gov identifier).

AB - Background: Achilles tendon ruptures often result in long-term functional deficits despite accelerated (standard) rehabilitation. Purpose/Hypothesis: The purpose of this study was to investigate if delayed loading would influence functional, clinical, and structural outcomes of the muscles and tendon 1 year after a surgical repair. It was hypothesized that delaying the loading would reduce the heel-rise height deficit 1 year after Achilles tendon rupture. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In total, 48 patients with a surgically repaired Achilles tendon rupture were randomized to 2 groups: the standard group received the currently accepted rehabilitation, and the delayed group received the same rehabilitation except that initial loading was delayed by 6 weeks. The primary outcome was the heel-rise height difference between the injured and uninjured sides at 1 year. The secondary outcomes were (1) tendon length measured with magnetic resonance imaging, (2) muscle fascicle length and pennation angle of the gastrocnemius medialis muscle, (3) Doppler activity measured with ultrasonography, (4) Achilles tendon Total Rupture Score (ATRS), and (5) isometric muscle strength. Results: The mean heel-rise height deficits for the standard and delayed groups were −2.2 cm and −2.1 cm, respectively (P =.719). The soleus part of the tendon was already elongated 1 week after surgery in both groups without a between-group difference (side-to-side difference: standard, 16.3 mm; delayed, 17.5 mm; P =.997) and did not change over 52 weeks. The gastrocnemius tendon length was unchanged at 1 week but elongated over time without a between-group difference (side-to-side difference at 52 weeks: standard, 10.5 mm; delayed, 13.0 mm; P =.899). The delayed group had less Doppler activity at 12 weeks (P =.006) and a better ATRS (standard, 60 points; delayed, 72 points; P =.032) at 52 weeks. Conclusion: Delayed loading was not superior to standard loading in reducing the heel-rise height difference at 1 year. The data indirectly suggested reduced inflammation in the initial months and a better patient-reported outcome at 1 year in the delayed group. The soleus part of the tendon was already markedly elongated (35%) 1 week after surgery, while the length of the gastrocnemius tendon was unchanged at 1 week but was 6% elongated at 1 year. Together, these data indirectly suggest that the delayed group fared better, although this finding needs to be confirmed in future investigations. Registration: NCT04263493 (ClinicalTrials.gov identifier).

KW - Achilles tendon rupture

KW - heel-rise height

KW - surgery

KW - tendon healing

KW - tendon inflammation

KW - tendon length

U2 - 10.1177/03635465241227178

DO - 10.1177/03635465241227178

M3 - Journal article

C2 - 38353060

AN - SCOPUS:85185658400

VL - 52

SP - 1022

EP - 1031

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 4

ER -