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The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
Amar A. Suchak, MD1; Geoff P. Bostick, PT2; Lauren A. Beaupré, PhD, PT3; D'Arcy C. Durand, MD4; Nadr M. Jomha, MD, PhD, FRCS(C)5
1 Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, Edmonton, AB T6G 2B7, Canada
2 University of Alberta, 3-48 Corbett Hall, Edmonton, AB T6G 2G4, Canada
3 Orthopaedic Research, Department of Surgery, Capital Health, 1F1.52 WMC, Edmonton, AB T6G 2B7, Canada. E-mail address: Lauren.Beaupre@capitalhealth.ca
4 c/o Orthopedic Residency Program, University of Alberta, 2D2.01 WMC, Edmonton, AB T6G 2B7, Canada
5 Department of Surgery, University of Alberta, 2D2.32 WMC, Edmonton, AB T6G 2B7, Canada
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the University of Alberta Hospital Foundation, the Royal Alexandra Hospital Foundation, the Edmonton Orthopaedic Research Committee, and DJO Incorporated. 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.
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Investigation performed at the University of Alberta, Edmonton, Alberta, Canada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Sep 01;90(9):1876-1883. doi: 10.2106/JBJS.G.01242
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Background: The optimal rehabilitation protocol after surgical repair of an Achilles tendon rupture has not been well defined. The objective of this randomized study was to compare the effect of early weight-bearing with that of non-weight-bearing on early postoperative recovery following repair of an acutely ruptured Achilles tendon.

Methods: Between October 2003 and May 2006, 110 patients with a surgically repaired Achilles tendon rupture were enrolled from one of two major trauma-care tertiary hospitals. All patients were non-weight-bearing for the first two weeks postoperatively. At the two-week postoperative visit, patients were randomized to either weight-bearing or non-weight-bearing for an additional four weeks. Compliance was measured with a pressure sensor in the fixed-hinge ankle-foot orthosis given to each patient. Follow-up assessments were performed at six weeks, three months, and six months postoperatively. The primary outcome was health-related quality of life assessed with use of the RAND 36-Item Health Survey (RAND-36). Secondary outcomes were activity level, calf strength, ankle range of motion, return to sports and work, and complications.

Results: Ninety-eight patients (89%) completed the six-month follow-up. At six weeks, the weight-bearing group had significantly better scores than the non-weight-bearing group in the RAND-36 domains of physical functioning, social functioning, role-emotional, and vitality scores (p < 0.05). Patients in the weight-bearing group also reported fewer limitations of daily activities at six weeks postoperatively (p < 0.001). At six months, no significant differences between the groups were seen in any outcome, although both groups had poor endurance of the calf musculature. No rerupture occurred in either group.

Conclusions: Early weight-bearing after surgical repair of an acute Achilles tendon rupture improves health-related quality of life in the early postoperative period and has no detrimental effect on recovery.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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