Thank you for having me here. My name is Najeeb Yusuf, and I'm a third-year resident from Henry Ford in Detroit, Michigan. And today I'll be talking about comparison of tendon lengthening with traditional versus accelerated rehab following Achilles tendon repair, and this is a prospect of randomized control trial. So what we wanted to look at was, does an early weight-bearing protocol affect post-op tendon elongation after Achilles tendon repair? A little bit of background. There's been a lack of consensus regarding the best post-op rehab protocol after Achilles tendon repair. Things we look at, range of motion, amount of weight-bearing versus immobilization. Prolonged immobilization can have adverse effects, theoretically adhesions, muscle atrophy. And recently, studies have shown a positive effect of early functional weight-bearing. However, concern for re-rupture with early weight-bearing is a thing. However, initial reports don't demonstrate an increased rate of re-rupture. So purpose of our study, primary outcomes, tendon elongation measured on X-ray and CT scan. And secondary measures included strength testing, patient-reported outcome measures, return to sport and work. Our methods inclusion criteria included acute tendon ruptures, less than six weeks. And the exclusion criteria were chronic ruptures or a history of a prior rupture. For our radiographic marker beads, the first bead was placed at the repair bone interface between the calcaneus and rupture site. And the second bead was placed two centimeters proximal to this. And following repair, before patients went home, they underwent imaging with X-ray and CT scan. At two weeks post-op, they underwent an X-ray. All X-rays were taken in 20 degrees of plantar flexion. At six weeks, they underwent another X-ray. At three weeks, or at the third post-op visit, at 12 weeks, they underwent X-ray and CT scan. And then strength testing at six months and 12 months. For a rehab protocol or accelerated rehab consisted of non-weight-bearing and a splint, 20 degrees of plantar flexion. At two weeks, weight-bearing is tolerated with two heel wedges. At four weeks, one wedge and a boot. And at six weeks, weight-bearing, a flat foot with the boot discontinued. Traditional rehab was six weeks of non-weight-bearing and a cast, and then weight-bearing is tolerated. This is an example of some post-operative X-rays. Here on the left is initial post-op, and at 12 weeks in the same patient post-op, you can see some elongation here. So results, we have 10 subjects in the accelerated group and eight in the traditional group. Average age was 37, 36, respectively. And average time to surgery was 9.8 days in the accelerated group and six days in the traditional group. Looking at repair elongation, this is a bead-to-bead distance. At two weeks, six weeks, and 12 weeks, there was no significant difference between the two groups. This is looking at intratendinous elongation, which is a measure of the elongation looking at the distance of the bone to the distal bead. And there was no significant elongation between the two groups, and the elongation itself was very minimal. Limitations of our study, there are different surgical techniques between the two surgeons participating in the study. One used the Bonnell-type repair, and the other used the Krakow-type repair, and we have a limited sample size as well. So conclusions, this study's findings suggest that all patients undergoing operative repair of Achilles tendon ruptures have significant lengthening after surgery, and there was no difference in lengthening at two weeks, six weeks, and final follow-up between the two groups. Thank you.

Najeeb Yusuf

tendon lengthening

accelerated rehabilitation

Achilles tendon repair

post-operative tendon elongation