Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Karolinska University Hospital, Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Stockholm, Sweden.
J Orthop Res. 2022 Aug;40(8):1932-1942. doi: 10.1002/jor.25199. Epub 2021 Oct 28.
This study aimed to compare recovery of gait patterns in patients treated with early functional mobilization (EFM) or standard treatment (ST) after Achilles tendon rupture repair. Second, this study aimed to explore associations between gait patterns and tendon elongation and calf muscle atrophy, respectively. Forty-seven patients (12 females), mean age 38.7 (7.3) years, were included. Patients were postoperatively randomized to EFM (n = 29), including immediate weightbearing and ankle motion for 6 weeks, or ST (n = 18), with 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis. Three-dimensional gait analyses were performed at 8 weeks and 6 months postoperatively to evaluate ankle and knee kinematics and kinetics. Ultrasound imaging was performed to assess tendon length and calf muscle atrophy. At 8 weeks, there were no significant group differences in ankle and knee kinematics and kinetics, while side-to-side differences between injured and uninjured side were present within both groups. At 6 months, the ST group exhibited higher generating ankle power and greater peak moments in ankle and knee compared to the EFM group. In both groups, peak ankle dorsiflexion angle was greater on the injured side compared to the uninjured side. No correlations were found between ankle joint gait deviations and degree of tendon elongation or muscle atrophy. Clinical significance: The accelerated rehabilitation regimen with EFM did not result in a more symmetrical gait pattern. The gait pattern deviations in the ankle joint were not related to the degree of muscle atrophy or tendon elongation.
本研究旨在比较接受早期功能活动（EFM）或标准治疗（ST）治疗的跟腱断裂修复后患者步态模式的恢复情况。其次，本研究旨在分别探讨步态模式与跟腱延长和小腿肌肉萎缩之间的关系。47 名患者（12 名女性），平均年龄 38.7（7.3）岁，纳入研究。术后患者随机分为 EFM 组（n=29），包括立即负重和踝关节运动 6 周，或 ST 组（n=18），用石膏固定 2 周，然后用矫形器负重 4 周。术后 8 周和 6 个月进行三维步态分析，以评估踝关节和膝关节的运动学和动力学。超声成像用于评估跟腱长度和小腿肌肉萎缩。8 周时，两组踝关节和膝关节的运动学和动力学均无显著组间差异，而两组内均存在受伤侧与未受伤侧之间的侧间差异。6 个月时，ST 组与 EFM 组相比，踝关节产生的功率更高，踝关节和膝关节的峰值力矩更大。两组中，受伤侧的踝关节背屈峰值角度均大于未受伤侧。踝关节步态偏差与跟腱延长或肌肉萎缩程度之间无相关性。临床意义：EFM 的加速康复方案并未导致更对称的步态模式。踝关节的步态模式偏差与肌肉萎缩或跟腱延长的程度无关。
