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Medial gastrocnemius myotendinous junction displacement and plantar-flexion strength in patients treated with immediate rehabilitation after Achilles tendon repair [with consumer summary]
de la Fuente CI, Lillo RP, Ramirez Campillo R, Ortega-Auriol P, Delgado M, Alvarez-Ruf J, Carreno G
Journal of Athletic Training 2016 Dec;51(12):1013-1021
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

CONTEXT: Pathologic plantar flexion frequently occurs after operative repair of the Achilles tendon (AT) because of immobilization and non-weight bearing in the first weeks of traditional rehabilitation. Novel rehabilitation strategies that apply mobilization and weight bearing have been proposed, but their effects on medial gastrocnemius myotendinous junction displacement (MJD) and isometric plantar-flexion strength (PFS) are unknown. OBJECTIVE: To compare the effects of 12 weeks of immediate versus traditional rehabilitation on MJD and PFS in patients with percutaneous AT repair and to compare AT rupture scores (ATRSs) during follow-up. DESIGN: Controlled laboratory study. SETTING: Human performance laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 26 amateur soccer players (age 42.3 +/- 9.7 years, body mass index 29.5 +/- 3.9 kg/m2) with percutaneous AT repair. INTERVENTION(S): Athletes were randomly divided into 2 groups: an immediate group, given physical therapy from day 1 to day 84, and a traditional group, given physical therapy from day 29 to day 84. We used repeated-measures analysis of variance to compare the data. MAIN OUTCOME MEASURE(S): We measured MJD and PFS at days 28 (fourth week), 56 (eighth week), and 84 (12th week) after AT repair. RESULTS: After 12 weeks of rehabilitation, we observed a large clinically meaningful effect and statistical difference between groups. At day 28, the immediate group showed higher values for PFS (p = 0.002), MJD (p = 0.02), and ATRS (p = 0.002) than the traditional group. At day 56, the immediate group presented higher values for MJD (p = 0.02) and ATRS (p = 0.009). At day 84, the immediate group registered more MJD (p = 0.001). CONCLUSIONS: Compared with traditional rehabilitation, 12 weeks of immediate rehabilitation after percutaneous AT repair resulted in better MJD, PFS, and ATRS after 4 weeks; better MJD and ATRS after 8 weeks; and better MJD after 12 weeks.

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