Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
Am J Sports Med. 2019 Mar;47(4):894-900. doi: 10.1177/0363546518824326. Epub 2019 Feb 11.
Mechanical loading is essential for tendon healing and may explain variability in patient outcomes after Achilles tendon rupture (ATR) repair. However, there is no consensus regarding the optimal postoperative regimen, and the actual amount of loading during orthosis immobilization is unknown.
The primary aim of this study was to assess the number of steps and the amount of loading in a weightbearing orthosis during the first 6 weeks after surgical ATR repair. A secondary purpose was to investigate if the amount of loading was correlated to fear of movement and/or experience of pain.
Case series; Level of evidence, 4.
Thirty-four patients (mean ± SD age, 38.8 ± 8.7 years) with ATR repair were included. Early functional mobilization was allowed postoperatively in an orthosis with adjustable ankle range of motion. During the first postoperative 2 weeks, patient-reported loading and pain were assessed with a visual analog scale and step counts with a pedometer. At the 2- and 6-week follow-up, a mobile force sensor was used for measuring plantar force loading, and the Tampa Scale for Kinesiophobia was used to examine fear of movement.
Between the first and second weeks, there was a significant increase in the mean number of daily steps taken (from 2025 to 2753, P < .001) as well as an increase in self-reported loading (from 20% to 53%, P < .001). Patient self-reported loading was significantly associated with the plantar force measurement (rho = 0.719, P < .001). At 6 weeks, loading was 88.2% on the injured limb versus the uninjured limb. Fear of movement was not correlated with pedometer data, subjective loading, pain, or force data. Patients with less pain during activity, however, reported significantly higher subjective load and took more steps ( P < .05).
This is the first study to demonstrate the actual loading patterns during postoperative functional mobilization among patients with surgically repaired ATR. The quick improvements in loading magnitude and frequency observed may reflect improved tendon loading essential for healing. Pain, rather than fear of movement, was associated with the high variability in loading parameters. The data of this study may be used to improve ATR rehabilitation protocols for future studies.
NCT02318472 (ClinicalTrials.gov).
机械加载对于跟腱愈合至关重要，这可以解释跟腱断裂（ATR）修复后患者结局的差异。然而，目前对于术后的最佳治疗方案尚未达成共识，并且在矫形器固定期间实际的加载量也不明确。
本研究的主要目的是评估 ATR 修复术后 6 周内承重矫形器的步数和加载量。次要目的是研究加载量是否与运动恐惧和/或疼痛体验相关。
病例系列研究；证据等级，4 级。
纳入 34 例 ATR 修复患者（平均年龄 38.8 ± 8.7 岁）。术后早期在可调节踝关节活动范围的矫形器中允许进行早期功能活动。在术后的头 2 周内，使用视觉模拟量表评估患者的主观加载和疼痛，使用计步器评估步数。在第 2 和第 6 周的随访中，使用移动力传感器测量足底力加载，使用坦帕运动恐惧量表（Tampa Scale for Kinesiophobia）评估运动恐惧。
在第 1 周到第 2 周之间，患者每日平均步数明显增加（从 2025 步增加至 2753 步，P <.001），同时主观加载量也增加（从 20%增加至 53%，P <.001）。患者的主观加载量与足底力测量值显著相关（rho = 0.719，P <.001）。在第 6 周时，患侧肢体的加载量为健侧肢体的 88.2%。运动恐惧与计步器数据、主观加载量、疼痛或力数据均无相关性。然而，活动时疼痛较轻的患者报告的主观负荷和步数明显更高（P <.05）。
这是第一项研究，旨在展示手术修复 ATR 患者术后功能活动期间的实际加载模式。观察到的加载量和频率的快速改善可能反映了愈合所必需的肌腱加载的改善。与加载参数的高变异性相关的是疼痛，而不是运动恐惧。本研究的数据可用于改进未来 ATR 康复方案。
NCT02318472（ClinicalTrials.gov）。
