Recovery of Muscle Power Following Early Weight-Bearing and Ankle Exercise after Surgical Repair of Acute Achilles Tendon Rupture

Ah-Young Jun; Boo-Geun Hwang; Seung-Hwan Cha; Do-Yong Kim; Hyong-Nyun Kim; Yong-Wook Park; Sang-Soo Lee

doi:10.4055/jkoa.2012.47.2.111

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Jun, Hwang, Cha, Kim, Kim, Park, and Lee: Recovery of Muscle Power Following Early Weight-Bearing and Ankle Exercise after Surgical Repair of Acute Achilles Tendon Rupture

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(2): 111-118.

Published online: 30 April 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.2.111

Recovery of Muscle Power Following Early Weight-Bearing and Ankle Exercise after Surgical Repair of Acute Achilles Tendon Rupture

Ah-Young Jun, M.D.^*,^§, Boo-Geun Hwang, Ph.D.^†, Seung-Hwan Cha, M.D.^*,^‡, Do-Yong Kim, M.D.^*,^‡, Hyong-Nyun Kim, M.D.^*,^‡, Yong-Wook Park, M.D.^∥, Sang-Soo Lee, M.D.^*,^‡

^*Institute for Skeletal Aging, College of Medicine, Hallym University, Chuncheon, Korea.

^†Department of Physical Education, College of Natural Science, Hallym University, Chuncheon, Korea.

^‡Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.

^§Department of Rehabilitation, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.

^∥Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.

Correspondence to: Sang-Soo Lee, M.D. Institute for Skeletal Aging, Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, 153, Gyo-dong, Chuncheon 200-704, Korea. TEL: +82-33-240-5198, FAX: +82-33-252-9875, totalhip@hallym.ac.kr

Received 28 February 2011 Revised 21 May 2011 Accepted 25 October 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the clinical results of early functional treatment after surgical repair of acute Achilles tendon rupture and to evaluate the isokinetic and isometric concentric plantar flexion peak torque and muscle endurance. We wanted to provide objective results of the functional improvement and the effect of early rehabilitation.

Materials and Methods

On a retrospective basis, we studied 52 cases of acute Achilles tendon rupture who visited our clinic between March 2007 and August 2009. Eleven patients (9 male, 2 female) were available for the follow-up more than 12 months and their mean final follow-up duration was 18.2 (12 to 39) months. We performed early weight-bearing and ankle exercise after surgical repair of acute Achilles tendon rupture. At final follow-up, patients were evaluated with clinical and functional examination using Arner-Lindholm scale and American Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale and patients' subjective satisfaction. In addition, the isokinetic and isometric concentric plantar flexion peak torque and muscle endurance were evaluated.

Results

Evaluating the clinical results using the Arner-Lindholm scale, we had 4 excellent cases and 7 good cases. The average AOFAS score was 88.9 (68 to 100) points at final follow-up. The patients' subjective satisfaction was excellent in 5 cases and good in 6 cases. The isokinetic concentric plantar flexion peak torque was restored to 92.2% (30°/sec) and 97.0% (120°/sec) in relation to the intact side at final follow-up. The isometric concentric plantar flexion peak torque was restored to 89.4% at 10o dorsiflexion, 84.4% at neutral, and 84.0% at 20° plantar flexion of the ankle position in relation to the intact side. The muscle endurance of ankle plantar flexor was 62.37% for the intact side and 59.16% for the injured side that there was no difference between the intact and injured side (p=0.79).

Conclusion

The clinical results and the satisfactory restoration of muscle power and endurance support early full weight bearing and exercise as an acceptable form of rehabilitation.

Keywords: Achilles tendon, acute Achilles tendon rupture, early rehabilitation, muscle strength, muscle endurance

Figures and Tables

Figure 1

Intraoperative photograph shows ruptured Achilles tendon repaired by single Krackow suture technique with 2.0 Ethibond® (Ethicon Inc., Somerville, NJ, USA).

Figure 2

Con-Trex dynamometer (CMV AG, Dubendorf, Switzerland) was used to measure isometric and isokinetic ankle strengths.

Figure 3

Bar graphs show the isokinetic peak torque of plantar flexior in the injured side and the intact side at the speed of 30°/sec and 120°/sec which showed no significant difference.

Figure 4

Bar graphs show the isometric peak torque of plantar flexor in the injured side and the intact side with ankle position at dorsiflexion 10°, neutral position, and plantarflexion 20°, which showed no significant difference. DF, dorsiflexion; PF, plantarflexion.

Figure 5

Bar graphs show the muscle endurance of the plantar flexor measured in the injured side and in the intact side. It was 62.37%, and 59.16% respectively.

Table 1

Patients Demographics

Table 2

Clinical Results of 11 Patients

^*Values are the rate of MCC in injured side compared to intact side. MCC, mid calf circumferential differences; ROM, range of motion; AOFAS, American Orthopedic Foot and Ankle Society ankle-hindfoot scale.

Table 3

Isometric and Isokinetic Concentric Plantar Flexion Peak Torque (Nm) in 11 Patients with Surgically Treated Total Ruptures of the Achilles Tendon

DF, dorsiflexion; PF, plantar flexion.

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