SLR - June 2011 - Jonathan L. Brown (1)
Reference: Saxena, A; Ewen, B; Maffulli, N. (2011). Rehabilitation of the Operated Achilles Tendon: Parameters for Predicting Return to Activity. The Journal of Foot and Ankle Surgery, 50(1): 37-40.
Scientific Literature Review
Reviewed by: Jonathan L. Brown, DPM
Residency Program: DVA San Francisco
Podiatric Relevance:
A standardized practice for rehabilitation of Achilles tendon surgeries has not yet been universally adopted. This study shows that podiatric practitioners and their assisting colleagues can use simple and easily measurable parameters to advise patients in their recovery, along with the typical time frames to return to activity (RTA).
Methods:
A retrospective review of two hundred and nineteen patients from a single surgeon’s practice was performed by a research assistant not involved in their surgical treatment to evaluate if rehabilitation program parameters were representative of ability to RTA. Surgical indications were acute rupture or chronic tendinopathy that failed appropriate non-surgical treatment over a suitable time period. Retrospective analysis of time to RTA was evaluated for patients undergoing various Achilles tendon surgeries. The RTA for each given procedure was retrospectively calculated and each individual patient was compared to a guideline, based on previous authors’ reported ranges. While adhering to a formal physical therapy regimen, the authors evaluated whether patients were able to meet 3 criteria: ability to perform 5 sets of 25 single-legged concentric heel raises, symmetry of calf girth, and ankle range of motion. They evaluated whether or not these parameters showed significance in predicting the ability to RTA within a normal range.
Results:
Of the 219 surgeries, fourteen patients could not to meet all 3 parameters within the proposed time frames. Three patients were unable to meet 2 of the 3 criteria. Two males had a delay in RTA as compared with eleven females (P<.0001). RTA in weeks varied among procedures as follows: peritenolysis 6.5 ± 2.8 weeks (n=30), debridement patients 14.0 ± 4.7 weeks (n=43), incision of insertional calcification with tenodesis 17.7 ± 5.9 weeks (n=73), retrocalcaneal exostectomy with tenodesis 20.5 ± 10.7 weeks (n=39), acute rupture 21.8 weeks ± 4 weeks (n=27), and chronic repair with tendon transfer 31.6 ± 7.8 weeks (n=7).
Conclusions:
Using simple and easily measurable parameters, the authors were able to show that one can reasonably predict the ability to RTA. They also show that RTA for a given Achilles procedure is variable.