Early rehabilitation protocol after Achilles tendon tenorraphy: ultrasonography and elastosonography difference with immobilization in cast: an observational study.

Abstract

Background The incidence of Achilles tendon (AT) rupture increased, but there is no gold standard treatment. The aim of this study is to compare clinical and functional results of standard and fast rehabilitation program (immobilization and no weight bearing for 4 weeks vs early joint mobility and weight bearing). Methods 33 patients underwent to open achilles tenorraphy between January and July 2018 using Krackow suture.15 patients were enrolled and underwent fast rehabilitation program. A control group of 18 patients underwent surgery and standard protocol. The degree of sural triceps hypotrophy compared with the controlateral leg (calf circumference 4 cm below the anterior tibial tuberosity and the tibial length), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score [8], the Victorian Institute of Sports Assesement - Achilles Questionnaire (VISA-A) [9] and The Achilles tendon Total Rupture Score (ATRS) [10] were recorded at 12 months follow up. Ultrasonography and elastosonography were used to calculate different parameters both on the operated tendon and on the contralateral. Discussion Using ultrasonography, the only significant difference was recorded in the distal depth in both groups. We detected an increase of all measures in both groups comparing surgical side to the contralateral one. Using the elastosonography, the stiffness on healthy side was increased at the proximal and medial third in standard group, even if the distal third was major in fast group. On the operated side, stiffness was more on the proximal third in fast group (not statistically significant). There was an increase of tendon size on the surgical side compared to the “basal” one using US. The only statistically significant result was at distal third, and it could be due to the fact that giving an accelerated mobilization stimulates more collagen deposition, which could be a protective factor. Furthermore, at distal third of tendon we observed a greater reduction of stiffness in the fast group compared of the standard one. The results of the post-operative assessment scales are overlapping in the two groups. Clinical and functional evidence suggest that fast rehabilitation after AT surgical repair may be a first choice of treat, especially in young and active patients, because of minor local complications and higher level of satisfaction.