Copyright © 2008 by The Journal of Bone and Joint Surgery, Inc.
Commentary & Perspective
Commentary & Perspective by
Nicola Maffulli MD, MS, PhD, FRCS(Orth), and Umile Giuseppe Longo, MD*,
Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom (N.M.), and Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy (U.G.L.)
Posted September 2008
Evidence-based orthopaedic surgery emphasizes the need to properly design and perform high-quality randomized controlled trials to minimize bias and to truly ensure the effectiveness of orthopaedic interventions. The currently available best evidence suggests that, after an open repair for an acute rupture of the Achilles tendon, the preferred rehabilitation protocol is to load and move the tendon1-4.
This study strengthens the evidence of the positive effect of early weight-bearing on early postoperative recovery following open repair of an acute rupture of the Achilles tendon.
In the past decade, new techniques of percutaneous repair of the Achilles tendon have been proposed5-7. They allow accurate juxtaposition of the tendon ends while minimizing the length of surgical incisions.
Knowledge about the risks and benefits of early weight-bearing after percutaneous repair of an acute rupture of the Achilles tendon, as reflected in the information published to date, is still incomplete. Clearly, studies that attain higher levels of evidence (for instance, large randomized trials) should be conducted to help answer the question of whether early weight-bearing is a good option after percutaneous repair of an acute rupture of the Achilles tendon.
The current trial was well planned and executed and was adequately powered to be able to safely ascertain that load and motion are not deleterious following an open repair of an acute Achilles tendon tear. The issue of whether return to sport and to an active lifestyle are quicker with early weight-bearing and motion is still unresolved, as it appears that these variables are not influenced by a more aggressive postoperative rehabilitation regimen, although patients in the weight-bearing group reported fewer limitations of daily activities and better physical functioning, social functioning, role-emotional, and vitality scores at six weeks postoperatively. Future trials should make use of validated functional and clinical outcome measures and should use adequate methodology and be sufficiently powered. The recent development of condition-specific patient-based outcome measures should be helpful. Such trials are ongoing in our institution, and our preliminary results confirm that early weight-bearing is also a safe option after percutaneous repair of acute rupture of the Achilles tendon.
*The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
References
1. Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med. 2003;31:692-700.
2. Maffulli N, Tallon C, Wong J, Peng Lim K, Bleakney R. No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness. 2003;43:367-79.
3. Kangas J, Pajala A, Siira P, Hämäläinen M, Leppilahti J. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma. 2003;54:1171-81.
4. Speck M, Klaue K. Early full weightbearing and functional treatment after surgical repair of acute Achilles tendon rupture. Am J Sports Med. 1998;26:789-93.
5. Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:199-203.
6. McClelland D, Maffulli N. Percutaneous repair of ruptured Achilles tendon. J R Coll Surg Edinb. 2002;47:613-8.
7. Movin T, Ryberg A, McBride DJ, Maffulli N. Acute rupture of the Achilles tendon. Foot Ankle Clin. 2005;10:331-56.
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