Open AccessFunctional weight‐bearing mobilization after Achilles tendon rupture enhances early healing response: a single‐blinded randomized controlled trial
Author(s) -
Valkering Kars P.,
Aufwerber Susanna,
Ranuccio Francesco,
Lunini Enricomaria,
Edman Gunnar,
Ackermann Paul W.
Publication year - 2017
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-016-4270-3
Subject(s) - medicine , weight bearing , heel , achilles tendon , achilles tendon rupture , randomized controlled trial , mobilization , microdialysis , surgery , anesthesia , tendon , anatomy , history , archaeology , central nervous system
Purpose Functional weight‐bearing mobilization may improve repair of Achilles tendon rupture (ATR), but the underlying mechanisms and outcome were unknown. We hypothesized that functional weight‐bearing mobilization by means of increased metabolism could improve both early and long‐term healing. Methods In this prospective randomized controlled trial, patients with acute ATR were randomized to either direct post‐operative functional weight‐bearing mobilization ( n = 27) in an orthosis or to non‐weight‐bearing ( n = 29) plaster cast immobilization. During the first two post‐operative weeks, 15°–30° of plantar flexion was allowed and encouraged in the functional weight‐bearing mobilization group. At 2 weeks, patients in the non‐weight‐bearing cast immobilization group received a stiff orthosis, while the functional weight‐bearing mobilization group continued with increased range of motion. At 6 weeks, all patients discontinued immobilization. At 2 weeks, healing metabolites and markers of procollagen type I (PINP) and III (PIIINP) were examined using microdialysis. At 6 and 12 months, functional outcome using heel‐rise test was assessed. Results Healing tendons of both groups exhibited increased levels of metabolites glutamate, lactate , pyruvate, and of PIIINP (all p < 0.05). Patients in functional weight‐bearing mobilization group demonstrated significantly higher concentrations of glutamate compared to the non‐weight‐bearing cast immobilization group ( p = 0.045). The upregulated glutamate levels were significantly correlated with the concentrations of PINP ( r = 0.5, p = 0.002) as well as with improved functional outcome at 6 months ( r = 0.4; p = 0.014). Heel‐rise tests at 6 and 12 months did not display any differences between the two groups. Conclusions Functional weight‐bearing mobilization enhanced the early healing response of ATR. In addition, early ankle range of motion was improved without the risk of Achilles tendon elongation and without altering long‐term functional outcome. The relationship between functional weight‐bearing mobilization‐induced upregulation of glutamate and enhanced healing suggests novel opportunities to optimize post‐operative rehabilitation.