Speaker: Focus on strength, not range of motion, after Achilles tendon repair
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Successful rehabilitation after Achilles tendon repair should focus on strengthening the tendon and surrounding muscles, rather than range of motion, to avoid tendon elongation and functional impairment, according to a presenter.
“A ruptured Achilles tendon treated with surgery – sewn together – still stretches out for 6 months,” David I. Pedowitz, MD, an orthopedic foot and ankle specialist, said in his presentation at the Sports Medicine Symposium hosted by Rothman Orthopaedic Institute and the Philadelphia Eagles. “This is new information for us. We thought that at 3 months: ‘Go to town. Do whatever you want. The repair is awesome.’ No, it’s a little less than awesome,” he said.
Achilles tendon ruptures are misdiagnosed 25% of the time, according to Pedowitz. Despite the high rate of misdiagnoses, a correctly performed clinical exam is 100% effective. A positive Thompson test will suffice, he said. An MRI delays surgery and is not worth the cost. Place the patient in a boot with heel lifts and strive for early evaluation and early repair, he added.
The best outcomes after Achilles tendon repairs are seen in younger patients and athletes who are returning to a sport other than basketball, Pedowitz said. The only modifiable risk factor for a better outcome is a tighter repair, he explained.
Make the repair as tight as possible and test it, he said. The focus of rehabilitation should be on strengthening. He said that the patient should not run, jump or perform any passive range of motion (ROM) beyond 90° for 3 months after surgery. Performing ROM exercises too early will elongate the tendon and prevent the patient from generating power or strength, he added.
However, strengthening exercises should not be solely focused on the repaired Achilles.
“You have a 0.2% chance of getting an Achilles tear. But if you do, you have a 9% chance of tearing the other side. That is high,” Pedowitz said. “When I send patients for [rehabilitation] for Achilles tendon ruptures, I also try to include the other side because maybe there’s some protective value there.”
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Pedowitz DI. Ankle Injuries and field management. Presented at: Sports Medicine Symposium; May 13, 2022; Philadelphia.
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