Early Controlled Loading on Conservative Treated Achilles Tendon Ruptures
Märksõnad
Abstraktne
Kirjeldus
Treatment of Achilles tendon ruptures includes surgical repair or immobilization in an orthosis, followed by prolonged rehabilitation. Improved rehabilitation regimens still display imperfect recovery, with deficits such as persistent end-range muscle weakness, tendon elongation and incomplete return to pre-injury activity level. The underlying mechanisms are unknown, but are likely to involve molecular and cellular aspects of the early healing processes. Animal experiments have shown that short episodes of vigorous loading during tendon healing create a stronger tendon, and lead to less elongation than continuous loading. Early controlled training has also been shown to improve the material properties of surgically repaired tendons. However, more and more clinics now turn away from surgery and towards conservative treatment, while studies on rehabilitation mainly concern sutured tendons. It is therefore also important to understand how to best rehabilitate conservatively treated patients. The aim is to investigate the effect of early controlled loading on conservatively treated Achilles tendon ruptures.
The patients (age 18-60 years of age) are treated conservatively by receiving a removable foam walker boot at the emergency department. The patients are thereafter called by the principal investigator and are asked if they want to participate in the study. Patients who are interested in participating in the study receive oral and in written information about the study of the principal investigator of the study (Pernilla Eliasson).
After 2 weeks, the rupture is localized by ultrasound and 4 tantalum beads are implanted percutaneously in the proximal and distal part of the tendon. These beads are used for measurements of the mechanical properties of the tendon by using RSA.
The patients are thereafter randomized to early controlled loading or control.
All patients wear the foam walker boot for 7 weeks. Full weight-bearing is allowed as tolerated from the beginning. Both groups perform motion exercises outside the boot with 20 repetitions, 3 times per day as of 14 days after rupture.
The patients in the early loading group are provided with a special training pedal where pedal resistance can be increased during the treatment period. The patients will use this pedal twice a day starting 2 weeks after rupture.
After the initial 7 weeks, the patients are referred to physical therapists uninvolved in this research, but with the instruction to follow the regional rehabilitation guidelines for Achilles tendon ruptures.
Mechanical properties of the tendon will be estimated by measuring tendon length, cross-sectional area (CSA) and stiffness at week 7, 19 and 52.
The elastic modulus of the tendon at 19 weeks it the primary variable of this study.
At week 7, both the elastic and plastic deformation will be measured. Tendon CSA will be evaluated using computer tomography (CT). Tendon elongation will be evaluated by RSA at week 2, 7, 19 and 52. Calf muscle circumference, passive and active range of motion in the ankle joint and a heel-raise test will be performed at week 19 and 52.
The overall function will be assessed by the Achilles Tendon Rupture Score at 19 and 52 weeks.
Complications and re-ruptures will be registered.
Kuupäevad
| Viimati kinnitatud: | 05/31/2016 |
| Esmalt esitatud: | 06/09/2016 |
| Hinnanguline registreerumine on esitatud: | 06/14/2016 |
| Esmalt postitatud: | 06/19/2016 |
| Viimane värskendus on esitatud: | 06/14/2016 |
| Viimati värskendus postitatud: | 06/19/2016 |
| Õppe tegelik alguskuupäev: | 09/30/2015 |
| Eeldatav esmane lõpetamise kuupäev: | 10/31/2018 |
| Eeldatav uuringu lõpetamise kuupäev: | 10/31/2018 |
Seisund või haigus
Sekkumine / ravi
Device: Early loading
Other: Tendon strain exercises
Other: Early weight bearing
Faas
Käerühmad
| Arm | Sekkumine / ravi |
|---|---|
| Active Comparator: Control This constitutes the currently accepted regime and is therefore consider the control group (CTRL) with early range of motion and early weight bearing. The control group was allowed to have weight-bearing as tolerated from day 0. They are also instructed to perform tendon strain exercises 3 times each day from 2 weeks after the rupture. | |
| Experimental: Early loading The patients in the early loading group are also allowed to have weight-bearing as tolerated from day 0 and perform tendon strain exercises 3 times each day from 2 weeks after the rupture. The patients in this group will also remove the walker twice a day and use a special training pedal for 5 weeks (until walker removal). | Device: Early loading The patients will perform early loading by using a special training pedal for 5 weeks, starting 2 weeks after the rupture. The patients will remove the walker and train twice a day on this pedal. |
Abikõlblikkuse kriteeriumid
| Õppimiseks sobivad vanused | 18 Years To 18 Years |
| Uuringuks kõlblikud sood | All |
| Võtab vastu tervislikke vabatahtlikke | Jah |
| Kriteeriumid | Inclusion Criteria: - Complete Achilles tendon rupture placed in the mid-substance of the Achilles tendon - Presented within 14 days from injury - 18-60 years old Exclusion Criteria: - Inability to understand swedish - previous injured tendon - Diabetes mellitus - History of Rheumatoid disease - Treatment with steroids |
Tulemus
Esmased tulemusnäitajad
1. Modulus of Elasticity [19 weeks]
Sekundaarsed tulemusmõõdud
1. Tendon elongation [2, 7, 19 and 52 weeks after rupture]
2. Modulus of Elasticity [7 and 52 weeks after rupture]
3. Achilles tendon total rupture score (ATRS) [19 and 52 weeks after rupture]
4. Maximal range of motion [19 and 52 weeks after rupture]
5. Heel-rise [19 and 52 weeks after rupture]
6. Plastic deformation of the tendon [7 weeks after rupture]
7. Calf muscle circumference [19 and 52 weeks]
