Early functional mobilization (EFM) does not appear to offer any real benefit after surgical repair of an Achilles tendon rupture, according to a new study.
Achilles Tendon Repair: Little Benefit to Early Mobilization
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Secondary#achillestendonrupture#achillestendonrupturerepair#muscleatrophy
The findings from “Changes in Tendon Elongation and Muscle Atrophy Over Time After Achilles Tendon Rupture Repair: A Prospective Cohort Study on the Effects of Early Functional Mobilization,” published online on September 28, 2020 in The American Journal of Sports Medicine, indicate that while early functional mobilization leads to tendon elongation at early healing, there wasn’t a significant impact on overall patient outcomes.
The purpose of the study was to analyze differences in tendon and muscle morphology recovery over time between patients treated with early functional mobilization or standard treatment after Achilles tendon rupture repair.
Eighty-six patients were included in the prospective cohort study. After surgery, patients were randomly assigned to immediate postoperative weightbearing and ankle motion or to immobilization in a below-knee plaster cast for 2 weeks.
Patients reported outcomes and functional outcomes were assessed at 6 and 12 months. And at 2 and 6 weeks postoperatively, B-mode ultrasound imaging was performed.
At 6 months, the Achilles Tendon Total Rupture Score for the early mobilization group was 65.8 (18.7) compared to 56.8 (20.1; p = .045) for the standard treatment group. By 12 months postop the scores were 79.6 (15.8) and 78.9 (17.2; p = .87), respectively.
At 2 weeks, tendon elongation was greater in the EFM group, but by 6 and 12 months the standard treatment group had caught up. Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the early functional mobilization group (n = 55) and 1.67 (0.92) cm for the control group (n = 27).
There were also no significant differences in changes in the length and cross-sectional area of the Achilles tendon, and calf muscle atrophy between the two groups (p ≤.001).
The researchers wrote, “Early functional mobilization results in more Achilles tendon elongation at early healing, but this difference subsides over time. Early functional mobilization doesn’t seem to affect patient outcome via changes in tendon elongation, thickening or calf muscle atrophy.”
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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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