Rehabilitation Programs After Achilles Tendon Rupture

Achilles Tendon Rupture: Comparative Study Between Two Rehabilitation Programs.

The purpose of this study is to evaluate the effects of early mobilization versus traditional immobilization rehabilitation programs after surgical Achilles tendon repair on the mechanical (torque-angle and torque-velocity relationships) and electrical (neuromuscular activation) properties of the plantar- and dorsiflexor muscles, gastrocnemius medialis morphology (muscle architecture), functional performance, and the mechanical and material properties (force-elongation and stress-strain relationships) of the injured and uninjured Achilles tendon.

The hypothesis is that the early mobilization could reduce the deleterious effects of the joint immobilization and improve the tendon healing.

Study Overview

• Status: Completed
• Conditions: Rupture of Achilles Tendon; Rupture, Spontaneous; Immobility Response, Tonic
• Intervention / Treatment: Other: Traditional Immobilization; Other: Early Mobilization

Detailed Description

Participants were allocated into one of two intervention groups (traditional immobilization or early mobilization).

Traditional immobilization group (45 days of plaster cast immobilization; after the immobilization period, subjects received instructions on how to perform a home-based exercise program)

Early mobilization (six weeks of physical therapy program; three times per week; one to two hours of exercises for regaining range of motion and muscular endurance)

Control group (subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized.

• Study Type: Interventional
• Enrollment (Actual): 47
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • Rio Grande do Sul
    • Porto Alegre, Rio Grande do Sul, Brazil, 90690-200
      • Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 60 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Male
• Achilles tendon rupture

Exclusion Criteria:

• arterial insufficiency
• diabetes
• autoimmune disease
• patients who used systemic antibiotics or steroids or showed any other clinical contraindication to perform maximum voluntary contractions on a dynamometer.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Traditional Immobilization; 45 days of plaster cast immobilization After the immobilization period, subjects received instructions on how to perform a home-based exercise program	Other: Traditional Immobilization; After surgery subjects were immobilized in a plaster cast, with the ankle positioned in gravitational equinus; weight bearing was not allowed. Two weeks post-operatively, the cast was removed and the patient was immobilized with a new plaster cast, with the ankle in the same position. Four weeks post-operatively, the ankle was plastered in neutral position (i.e. with the sole of the foot perpendicular to the shank), and weight bearing was encouraged. Six weeks post-operatively, the plaster cast was removed The home exercise program consisted of active exercises and stretches to improve ankle range of motion, and resistance and balance exercises; Other Names: Plaster cast immobilization
EXPERIMENTAL: Early mobilization; Six weeks of physical therapy program	Other: Early Mobilization; The physical therapy started two weeks after the surgery and lasted six weeks, during which a removable brace was used. Therapy sessions, three times per week in the six-week period, included one to two hours of exercises for regaining range of motion and muscular endurance.; Other Names: Accelerated rehabilitation
NO_INTERVENTION: Control; Subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Torque change	Torque is an expression of the muscular strength and was assessed by dynamometry	Torque was measured 3 times during the study: three, six and more than 12 months after surgical repair.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscular architecture change	Muscular architecture (muscle thickness, pennation angle and fascicle length) was assessed by ultrasonography	Muscle architecture was measured 4 times during the study: 45 days, three, six and more than 12 months after surgical repair.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscular electrical activation change	Electrical activation was assessed by electromyography (EMG)	Muscular electrical activation was measured 3 times during the study: three, six and more than 12 months after surgical repair
Tendon mechanical and material properties change	Tendon mechanical and material properties were assessed by Achilles tendon elongation (measured by ultrasound) during isometric plantar flexion ramp contraction as a function of ankle joint torque.	Tendon mechanical and material properties were measured 3 times during the study: three, six and more than 12 months after surgical repair.
Functional performance change	Functional performance was assessed by functional tests (standing heel-rise, time up and go and jump tests) and AOFAS questionnaire.	Functional performace was measured 3 times during the study: three, six and more than 12 months after surgical repair

Collaborators and Investigators

• Sponsor: Federal University of Rio Grande do Sul
• Collaborators: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.; Conselho Nacional de Desenvolvimento Científico e Tecnológico

Study record dates

Study Major Dates

• Study Start: March 1, 2008
• Primary Completion (ACTUAL): August 1, 2014
• Study Completion (ACTUAL): August 1, 2014

Study Registration Dates

• First Submitted: December 2, 2014
• First Submitted That Met QC Criteria: December 2, 2014
• First Posted (ESTIMATE): December 4, 2014

Study Record Updates

• Last Update Posted (ESTIMATE): December 4, 2014
• Last Update Submitted That Met QC Criteria: December 2, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: Rehabilitation; Functionality; Immobilization; Achilles tendon rupture; Weight-Bearing; Muscle architecture; Neuromuscular parameters
• Additional Relevant MeSH Terms: Wounds and Injuries; Pathological Conditions, Anatomical; Rupture; Rupture, Spontaneous
• Other Study ID Numbers: UFRGS - 2007882