Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study

M.L. Costa, L. Shepstone, C. Darrah, T. Marshall and S.T. Donell

Injury

Volume 34, Issue 11, November 2003, Pages 874-876

The traditional treatment following the surgical repair of an Achilles Tendon is serial cast bracing, where the heel is held in a raised position and gradually lowered over a period of weeks. However, more recent research has advocated early mobilisation of the ankle to restore ankle range of movement, as this has been shown to have a favourable effect on the ultimate strength of the healed tendon.

Data from experimental biomechanical research has suggested that early weight bearing may also have a positive affect on tendon healing. This is due to carefully controlled loading of the collagen fibres that make up the tendon tissue, which facilitates healing, bonds between fibres and functional alignment. Despite these beneficial effects, the clinical use of early weight bearing and mobilisation is not widespread. This may be due to a lack of randomised clinical trials to verify this approach.

After identifying this absence of research evidence, Costa et al have undertaken a pilot study to examine the efficacy of this regime. The authors examined the affect of early weight bearing and mobilising against serial casting and non-weight bearing in a group of 26 patients, who were randomly assigned to one of these groups. Each patient was reviewed at 2 week intervals for 8 weeks. At each visit, the wound was assessed, calf muscle bulk measured and return to normal activities monitored. At six weeks the tendon was assessed with an ultrasound scan. Each patient was then reviewed at 3 months, 6 months and after 1 year.

The results showed a return to sports in six months in the early loading group, compared to eight months in the plaster group. There was also less of a strength deficit in the early weight bearing group compared to the plaster group. The data presented in this paper supports the hypothesis that such loading and mobilisation may have functional benefits. This pilot study would suggest that immediate controlled weight-bearing mobilisation after Achilles Tendon repair is safe and may produce functional benefits for the patient. Further randomised controlled trials are necessary to further assess this rehabilitation strategy.

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