Does Early Mobilization Improve Achilles Tendon Outcomes?

A new study finds that early functional mobilization after surgery for acute Achilles tendon rupture does not lead to a faster recovery of calf muscle function.

The research, “Comparable Recovery and Compensatory Strategies in Heel-Rise Performance After a Surgically Repaired Acute Achilles Tendon Rupture: An In Vivo Kinematic Analysis Comparing Early Functional Mobilization and Standard Treatment,” was published online on November 2, 2022, in the American Journal of Sports Medicine. “Deficits in calf muscle function and heel-rise performance are common after an Achilles tendon rupture and are related to tendon elongation and calf muscle atrophy. Whether early functional mobilization can improve calf muscle function compared with standard treatment with 2 weeks of immobilization and unloading in a plaster cast is unknown,” the researchers wrote.

The Karolinska Institute and University of Delaware research team hypothesized that early functional mobilization following Achilles tendon repair would lead to faster recovery of heel-rise performance compared with standard treatment, but their resulting research data showed that early mobilization did not make a difference.

The team designed the study to randomize Achilles tendon repair patients to either early functional mobilization or standard treatment after surgery. The researchers then collected data from 3-dimensional motion analysis of heel-rise performance at 8 weeks and 6 months postoperatively. And at 6 months, they assessed patients’ tendon length and muscle volume with ultrasound imaging and calf muscle function with the heel-rise test. Patient-reported outcomes were measured using the Achilles tendon Total Rupture Score.

The research team found that there were no significant group differences between the early functional mobilization and standard treatments groups in heel-rise performance at 8 weeks and 6 months.

There were however significant side-to-side differences in ankle and knee kinematics. At 8 weeks and 6 months, both groups showed a significantly decreased peak ankle plantarflexion angle and increased knee flexion angle on the injured limb compared with the uninjured limb during bilateral heel raises.

Greater atrophy of the medial gastrocnemius muscle and higher body weight were predictors of a decreased maximum peak ankle plantarflexion angle on the injured limb at 6 months, the researchers reported.

“Increased knee flexion seemed to be a compensatory strategy for decreased ankle plantarflexion. Medial gastrocnemius atrophy and increased body weight were additional factors associated with a decreased ankle plantarflexion angle,” they wrote.

Study authors included Susanna Aufwerber, PT, Ph.D., Paul W. Ackermann, M.D., Ph.D. and Josefine E. Naili, PT, Ph.D., all from the Karolinska Institute, Stockholm, Sweden. Karin Grävare Silbernagel, PT, ATC, Ph.D. of the University of Delaware, Newark, also contributed to the study.