Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China.
Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China.
J Orthop Surg Res. 2024 Aug 21;19(1):497. doi: 10.1186/s13018-024-04970-y.
In recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair.
This study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected.
The recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences.
Immobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications.
ClinicalTrials.gov (NCT04663542).
近几十年来，人们提出在跟腱断裂（ATR）修复后进行早期康复。本前瞻性队列研究旨在比较不同的固定时间，以确定 ATR 修复后开放式手术的最佳固定时间。
本研究纳入了 1088 例（平均年龄 34.9±5.9 岁）接受急性 ATR 修复的开放式手术的患者。根据术后固定时间，患者被分为 4 组（A、B、C 和 D），分别为 0、2、4 和 6 周。所有患者在支具去除后均接受相同的缝合技术和相似的康复方案；术后 2、4、6、8、10、12、14 和 16 周进行临床检查，并在平均 19.0 个月时进行最终随访。主要结局为单腿跟腱抬高高度（OHRH）的恢复时间。次要结局包括恢复轻运动（LE）的时间和关节活动度（ROM）的恢复时间。还收集了手术时间、并发症、疼痛视觉模拟评分（VAS）、跟腱总断裂评分（ATRS）和美国矫形足踝协会（AOFAS）踝关节-后足评分的数据。
A 组和 B 组的 OHRH、LE 和 ROM 恢复时间明显短于 C 组和 D 组（P<0.001）。VAS 评分随时间下降，所有组在 10 周时均降至 0。A 组和 B 组在 2 周和 4 周时的评分均高于其他组（P<0.001），而在 8 周时则相反（P<0.001）。ATRS 和 AOFAS 踝关节-后足评分随时间在所有组中均升高，6 周到 16 周（P<0.001）和 6 周到 12 周（P<0.001）之间存在显著的组间差异。A 组和 B 组的评分优于 C 组和 D 组。观察到 38 例（3.5%）并发症，包括 20 例再断裂和 18 例浅表感染。所有并发症在最后一次随访时均已解决，无组间差异。
ATR 修复后开放式手术固定 2 周可能是早期康复的最佳策略，疼痛和其他并发症相对较少。
ClinicalTrials.gov（NCT04663542）。
