Kim Uk, Choi Yun Seong, Jang Gyu Chol, Choi Young Rak
Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seong-nam, Republic of Korea.
Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seong-nam, Republic of Korea.
Injury. 2017 Jul;48(7):1710-1713. doi: 10.1016/j.injury.2017.04.050. Epub 2017 Apr 25.
As outdoor activities participation increase, Achilles tendon rupture incidence also tends to increase. There are a number of treatment and rehabilitation options for a ruptured Achilles tendon. However, the optimal rehabilitation protocols are still under debate. The purpose of this study is to determine whether early rehabilitation is more effective than conventional rehabilitation.
Medical records of 56 patients who had been treated with open repair after a ruptured Achilles tendon were retrospectively reviewed. 24 patients were treated postoperatively with below knee cast immobilization for four weeks, and they started tolerable weight-bearing rehabilitation at four weeks' follow-up. The remaining 32 patients were managed postoperatively with short leg splint immobilization for two weeks and started the tolerable weight-bearing at two weeks' follow-up. We evaluated the patients several times to identify when the single heel raise was possible and measured the American Orthopedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) as a functional outcome.
The single heel raise test was positive in all patients at the last assessment. But there were no statistically significant differences between the groups (p=0.137). The patients in the Cast group took significantly more time to return to work than did the patients in the Splint group (p=0.032). And AOFAS scores and ATRS were slightly higher in the Splint group than in the Cast group. There were statistically significant differences (p=0.042, p=0.028) between the two groups.
The early rehabilitation did not lead to greater endurance, but it showed better results in the return to work and the Achilles functional score. Early rehabilitation after open repair for patients with a ruptured Achilles tendon is helpful for functional recovery. Type of study / Level of evidence: Therapeutic, Level III.
随着户外活动参与度的增加，跟腱断裂的发生率也有上升趋势。对于跟腱断裂有多种治疗和康复方案。然而，最佳的康复方案仍存在争议。本研究的目的是确定早期康复是否比传统康复更有效。
回顾性分析56例跟腱断裂后接受开放修复治疗患者的病历。24例患者术后用膝下石膏固定四周，在四周随访时开始进行可耐受的负重康复训练。其余32例患者术后用短腿夹板固定两周，并在两周随访时开始可耐受的负重训练。我们对患者进行了多次评估，以确定何时能够单足提踵，并测量美国矫形足踝协会（AOFAS）评分和跟腱完全断裂评分（ATRS）作为功能结局。
在最后一次评估时，所有患者的单足提踵试验均为阳性。但两组之间无统计学显著差异（p = 0.137）。石膏固定组患者比夹板固定组患者返回工作岗位所需的时间明显更长（p = 0.032）。夹板固定组的AOFAS评分和ATRS略高于石膏固定组。两组之间存在统计学显著差异（p = 0.042，p = 0.028）。
早期康复并未带来更强的耐力，但在返回工作岗位和跟腱功能评分方面显示出更好的结果。跟腱断裂患者开放修复术后的早期康复有助于功能恢复。研究类型/证据水平：治疗性研究，III级。
