Kangas Jarmo, Pajala Ari, Ohtonen Pasi, Leppilahti Juhana
Department of Surgery, Oulu University Hospital, Finland.
Am J Sports Med. 2007 Jan;35(1):59-64. doi: 10.1177/0363546506293255. Epub 2006 Sep 14.
A few prospective controlled trials comparing early functional rehabilitation after Achilles tendon repair and non-operative immobilization have been reported.
There is no difference in Achilles tendon elongation between early motion and immobilization after Achilles tendon repair. Tendon elongation does not correlate with the clinical outcome.
Randomized clinical trial; Level of evidence, 2.
Fifty patients with acute Achilles tendon rupture were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks or immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks. Full weightbearing was allowed after 3 weeks in both groups. Standardized radiographs to measure previously placed radiographic markers were taken on the first day postoperatively and at 1, 3, 6, 12, 24 weeks postoperatively, with the final radiograph a mean of 60 (SD, 6.4) weeks postoperatively. The outcome was assessed at the 3-month and final checkups by the clinical scoring method described by Leppilahti et al and included subjective factors and objective factors.
Tendon elongation occurred in both groups but was somewhat less in the early motion group (median 2 mm in the early motion group vs median 5 mm in the cast group a mean of 60 weeks postoperatively, P = .054). The elongation curves first rose and then slowly fell in both groups. The patients who had less elongation achieved a better clinical outcome (rho = -.42, P = .017). Tendon elongation did not correlate significantly with age, body mass index, or isokinetic peak torques.
Achilles tendon elongation was somewhat less in the early motion group and correlated with the clinical outcome scores. We recommend early functional postoperative treatment after Achilles rupture repair.
已有一些前瞻性对照试验报告了比较跟腱修复术后早期功能康复与非手术固定的情况。
跟腱修复术后早期活动与固定在跟腱延长方面无差异。肌腱延长与临床结果无关。
随机临床试验；证据等级，2级。
50例急性跟腱断裂患者术后随机分为两组，一组在支具中使踝关节在中立位和跖屈之间进行早期活动，持续6周；另一组使用膝下石膏将踝关节固定在中立位并保持张力，持续6周。两组均在3周后允许完全负重。术后第1天以及术后1、3、6、12、24周拍摄标准化X线片以测量先前放置的X线标记物，最后一张X线片平均在术后60（标准差，6.4）周拍摄。在3个月和最终检查时，采用Leppilahti等人描述的临床评分方法评估结果，包括主观因素和客观因素。
两组均出现肌腱延长，但早期活动组的延长程度稍小（术后60周时，早期活动组中位数为2mm，石膏固定组中位数为5mm，P = 0.054）。两组的延长曲线均先上升然后缓慢下降。延长程度较小的患者临床结果更好（rho = -0.42，P = 0.017）。肌腱延长与年龄、体重指数或等速峰值扭矩无显著相关性。
早期活动组的跟腱延长程度稍小，且与临床结果评分相关。我们建议跟腱断裂修复术后进行早期功能治疗。
