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Tendon Elongation and Function After Delayed or Standard Loading of Surgically Repaired Achilles Tendon Ruptures: A

Rikke Hoeffner^1,2,3, Anne-Sofie Agergaard^1,2,3, Rene B Svensson^1,2

¹Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.

The American Journal of Sports Medicine

|February 14, 2024

Summary

Delayed loading after Achilles tendon repair did not improve heel-rise height compared to standard rehabilitation. However, the delayed group showed reduced inflammation and better patient-reported outcomes, suggesting potential benefits.

Keywords:

Achilles tendon rupture heel-rise height surgery tendon healing tendon inflammation tendon length

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Published on: October 27, 2023

Area of Science:

Orthopedic surgery
Sports medicine
Rehabilitation science

Background:

Achilles tendon ruptures frequently lead to persistent functional limitations post-rehabilitation.
Current accelerated rehabilitation protocols may not fully restore function.

Purpose of the Study:

To evaluate the impact of delayed loading on functional, clinical, and structural outcomes after surgical Achilles tendon repair.
To test the hypothesis that delayed loading reduces the heel-rise deficit at one year post-rupture.

Main Methods:

A randomized controlled trial (Level 1 evidence) involving 48 patients with surgically repaired Achilles tendon ruptures.
Patients were assigned to either standard rehabilitation or a protocol with delayed initial loading (6 weeks).
Outcomes included heel-rise height, tendon and muscle fascicle length (MRI), Doppler activity (ultrasound), Achilles tendon Total Rupture Score (ATRS), and isometric strength at 1 year.

Main Results:

No significant difference in heel-rise height deficit between groups at 1 year (standard: -2.2 cm, delayed: -2.1 cm).
The delayed loading group exhibited less Doppler activity at 12 weeks and a higher ATRS at 52 weeks.
Tendon elongation was observed in both groups, with no significant between-group differences at 1 year.

Conclusions:

Delayed loading did not improve the primary outcome of heel-rise height compared to standard rehabilitation.
The delayed group showed potential benefits, including reduced early inflammation and improved patient-reported outcomes.
Further research is needed to confirm the long-term advantages of delayed loading protocols in Achilles tendon rupture recovery.