Abstract：
UNASSIGNED: Achilles tendon ruptures often result in long-term functional deficits despite accelerated (standard) rehabilitation.
UNASSIGNED: The purpose of this study was to investigate if delayed loading would influence functional, clinical, and structural outcomes of the muscles and tendon 1 year after a surgical repair. It was hypothesized that delaying the loading would reduce the heel-rise height deficit 1 year after Achilles tendon rupture.
UNASSIGNED: Randomized controlled trial; Level of evidence, 1.
UNASSIGNED: In total, 48 patients with a surgically repaired Achilles tendon rupture were randomized to 2 groups: the standard group received the currently accepted rehabilitation, and the delayed group received the same rehabilitation except that initial loading was delayed by 6 weeks. The primary outcome was the heel-rise height difference between the injured and uninjured sides at 1 year. The secondary outcomes were (1) tendon length measured with magnetic resonance imaging, (2) muscle fascicle length and pennation angle of the gastrocnemius medialis muscle, (3) Doppler activity measured with ultrasonography, (4) Achilles tendon Total Rupture Score (ATRS), and (5) isometric muscle strength.
UNASSIGNED: The mean heel-rise height deficits for the standard and delayed groups were -2.2 cm and -2.1 cm, respectively (P = .719). The soleus part of the tendon was already elongated 1 week after surgery in both groups without a between-group difference (side-to-side difference: standard, 16.3 mm; delayed, 17.5 mm; P = .997) and did not change over 52 weeks. The gastrocnemius tendon length was unchanged at 1 week but elongated over time without a between-group difference (side-to-side difference at 52 weeks: standard, 10.5 mm; delayed, 13.0 mm; P = .899). The delayed group had less Doppler activity at 12 weeks (P = .006) and a better ATRS (standard, 60 points; delayed, 72 points; P = .032) at 52 weeks.
UNASSIGNED: Delayed loading was not superior to standard loading in reducing the heel-rise height difference at 1 year. The data indirectly suggested reduced inflammation in the initial months and a better patient-reported outcome at 1 year in the delayed group. The soleus part of the tendon was already markedly elongated (35%) 1 week after surgery, while the length of the gastrocnemius tendon was unchanged at 1 week but was 6% elongated at 1 year. Together, these data indirectly suggest that the delayed group fared better, although this finding needs to be confirmed in future investigations.
UNASSIGNED: NCT04263493 (ClinicalTrials.gov identifier).
UNASSIGNED: The purpose of this study was to investigate if delayed loading would influence functional, clinical, and structural outcomes of the muscles and tendon 1 year after a surgical repair. It was hypothesized that delaying the loading would reduce the heel-rise height deficit 1 year after Achilles tendon rupture.
UNASSIGNED: Randomized controlled trial; Level of evidence, 1.
UNASSIGNED: In total, 48 patients with a surgically repaired Achilles tendon rupture were randomized to 2 groups: the standard group received the currently accepted rehabilitation, and the delayed group received the same rehabilitation except that initial loading was delayed by 6 weeks. The primary outcome was the heel-rise height difference between the injured and uninjured sides at 1 year. The secondary outcomes were (1) tendon length measured with magnetic resonance imaging, (2) muscle fascicle length and pennation angle of the gastrocnemius medialis muscle, (3) Doppler activity measured with ultrasonography, (4) Achilles tendon Total Rupture Score (ATRS), and (5) isometric muscle strength.
UNASSIGNED: The mean heel-rise height deficits for the standard and delayed groups were -2.2 cm and -2.1 cm, respectively (P = .719). The soleus part of the tendon was already elongated 1 week after surgery in both groups without a between-group difference (side-to-side difference: standard, 16.3 mm; delayed, 17.5 mm; P = .997) and did not change over 52 weeks. The gastrocnemius tendon length was unchanged at 1 week but elongated over time without a between-group difference (side-to-side difference at 52 weeks: standard, 10.5 mm; delayed, 13.0 mm; P = .899). The delayed group had less Doppler activity at 12 weeks (P = .006) and a better ATRS (standard, 60 points; delayed, 72 points; P = .032) at 52 weeks.
UNASSIGNED: Delayed loading was not superior to standard loading in reducing the heel-rise height difference at 1 year. The data indirectly suggested reduced inflammation in the initial months and a better patient-reported outcome at 1 year in the delayed group. The soleus part of the tendon was already markedly elongated (35%) 1 week after surgery, while the length of the gastrocnemius tendon was unchanged at 1 week but was 6% elongated at 1 year. Together, these data indirectly suggest that the delayed group fared better, although this finding needs to be confirmed in future investigations.
UNASSIGNED: NCT04263493 (ClinicalTrials.gov identifier).
摘要：
■跟腱断裂通常导致长期功能缺陷，尽管加速（标准）康复。
■这项研究的目的是调查延迟负荷是否会影响功能，临床,以及手术修复后1年肌肉和肌腱的结构结果。据推测，延迟加载将减少跟腱断裂后1年的脚跟上升高度不足。
■随机对照试验；证据水平，1.
■总共，将48例手术修复的跟腱断裂患者随机分为2组：标准组接受目前接受的康复治疗，延迟组接受了相同的康复治疗，只是最初的负荷延迟了6周。主要结果是1年时受伤侧和未受伤侧之间的脚跟上升高度差。次要结果是（1）用磁共振成像测量肌腱长度，(2)腓肠肌内侧肌的肌束长度和横摆角,（3）超声测量多普勒活动，（4）跟腱总断裂评分（ATRS），和(5)等距肌力。
■标准组和延迟组的平均脚跟上升高度缺陷分别为-2.2厘米和-2.1厘米，分别为（P=.719）。两组手术后1周，肌腱的比目鱼肌部分已经拉长，没有组间差异（左右差异：标准，16.3毫米；延迟，17.5毫米；P=.997），并且在52周内没有变化。腓肠肌肌腱长度在1周时没有变化，但随着时间延长，没有组间差异（52周时左右差异：标准，10.5毫米；延迟，13.0mm;P=.899)。延迟组在12周时多普勒活动较少（P=0.006），ATRS较好（标准，60分；延迟，72分；P=.032）在52周。
■延迟加载在减少1年时的脚跟高度差方面并不优于标准加载。数据间接表明，延迟组在最初几个月的炎症反应减少，在1年时患者报告的结果更好。手术后1周，肌腱的比目鱼肌部分已经明显延长（35％），而腓肠肌肌腱的长度在1周时没有变化，但在1年时延长了6％。一起,这些数据间接表明延迟组的表现更好，尽管这一发现需要在未来的调查中得到证实。
■NCT04263493（ClinicalTrials.gov标识符）。
■这项研究的目的是调查延迟负荷是否会影响功能，临床,以及手术修复后1年肌肉和肌腱的结构结果。据推测，延迟加载将减少跟腱断裂后1年的脚跟上升高度不足。
■随机对照试验；证据水平，1.
■总共，将48例手术修复的跟腱断裂患者随机分为2组：标准组接受目前接受的康复治疗，延迟组接受了相同的康复治疗，只是最初的负荷延迟了6周。主要结果是1年时受伤侧和未受伤侧之间的脚跟上升高度差。次要结果是（1）用磁共振成像测量肌腱长度，(2)腓肠肌内侧肌的肌束长度和横摆角,（3）超声测量多普勒活动，（4）跟腱总断裂评分（ATRS），和(5)等距肌力。
■标准组和延迟组的平均脚跟上升高度缺陷分别为-2.2厘米和-2.1厘米，分别为（P=.719）。两组手术后1周，肌腱的比目鱼肌部分已经拉长，没有组间差异（左右差异：标准，16.3毫米；延迟，17.5毫米；P=.997），并且在52周内没有变化。腓肠肌肌腱长度在1周时没有变化，但随着时间延长，没有组间差异（52周时左右差异：标准，10.5毫米；延迟，13.0mm;P=.899)。延迟组在12周时多普勒活动较少（P=0.006），ATRS较好（标准，60分；延迟，72分；P=.032）在52周。
■延迟加载在减少1年时的脚跟高度差方面并不优于标准加载。数据间接表明，延迟组在最初几个月的炎症反应减少，在1年时患者报告的结果更好。手术后1周，肌腱的比目鱼肌部分已经明显延长（35％），而腓肠肌肌腱的长度在1周时没有变化，但在1年时延长了6％。一起,这些数据间接表明延迟组的表现更好，尽管这一发现需要在未来的调查中得到证实。
■NCT04263493（ClinicalTrials.gov标识符）。
