While early weightbearing protocols have been proven to improve mobilization after Achilles tendon repair, there has been little data on its effects on tendon lengthening.
Rehab Type Doesn’t Affect Achilles Tendon Lengthening After Repair
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Secondary#achillestendonrupture#earlyweightbearingprotocols#tendonlengthening
A new study, “Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial,” published on March 23, 2020 in The American Journal of Sports Medicine, however, offers some insight.
In a small analysis of 18 patients, the researchers found that there was no difference in tendon lengthening between patients who underwent traditional or accelerated rehabilitation after surgery.
During the study, patients consented to have tantalum beads placed within their Achilles tendon during repair for acute rupture. This beads were used to measure tendon lengthening. Then after surgery, they were randomized to either traditional (weightbearing at 6 weeks) or accelerated (graduated weightbearing at 2 weeks) rehabilitation.
The primary outcome was postoperative tendon elongation as measured by the radiostereometric beads. Secondary outcomes included Achilles Tendon Total Rupture Score (ATRS) and Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (PROMISI PI-SF) score.
According to the data collected, there were no significant differences in overall lengthening between the traditional and accelerated rehabilitation groups (15.3±4.5 vs. 16.4±4.7 mm, respectively; p = .33). The biggest increase in lengthening happened between 2 and 6 weeks and the least amount between 6 and 12 weeks. This was found in both groups. Tendon lengthening decreased after 6 weeks.
In addition, no differences were found in ankle range of motion (dorsiflexion, p = .16; plantarflexion, p = .08) or outcome scores (ATRS, p = .56; PROMIS PI-SF, p = .54).
The researchers wrote, “This study’s findings demonstrate that all patients undergoing operative repair of Achilles tendon rupture had lengthening after surgery. No difference was found in tendon lengthening (repair site or intratendinous) at any time point between patients undergoing traditional versus accelerated rehabilitation postoperatively.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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