Accelerated rehabilitation following achilles tendon repair after acute rupture development of an evidencebased treatment protocol mareen brumann, sebastian f. Achilles repair rehabilitation protocol key considerations. Specific changes in the program will be made by the. Brace locked at 0 degrees for ambulation for 68 weeks with use of bilateral axillary crutches. The tendon transmits force from the contracting calf muscles to the calcaneus to cause the foot action of plantar. Placehold for hook, full and straight fist with wrist extended. Stability of a joint is maintained by connective tissue structures and the dynamic support of the surrounding. Repair and rehabilitation of zone five tendon injuries of. Place hold for isolated fds glide of involved digits. To evaluate the clinical outcome of early repair and rehabilitation of zone 5 tendon injuries of the wrist and return to work after trauma. Rehabilitation guidelines for lateral ankle reconstruction the ankle is a very complex joint. Accelerated achilles protocol indiana total therapy. Achilles tendon repair rehabilitation protocol tears of achilles tendon tend to happen in weekend athletes, and the repair tends to heal reliably. Specific changes in the program will be made by the physician as appropriate for the individual patient.
Achilles tendon repair postop protocol penrose physical. Zone 1, fdp flexor tendon repair protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a flexor tendon repair. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Flexor tendon repair therapy protocol sideline orthopedics. Quadriceps and patella tendon repair rehabilitation protocol phase i maximum protection weeks 0 to 6. Postop days 1 10 bracesplint watch for skin breakdown crutches non weight bearing nwb active motion arom hip and knee wiggle toes straight leg raise slr x 4 lower extremity le stretches hamstring, quads, itb, hip flexors ice. Calf girth, plantar flexor strength and ankle rom are all keys to full recovery. The tendon ends are identified and then sewn together. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making.
Comparing three postoperative treatment protocols for. Advice and exercises following your extensor tendon repair patient information clinical and diagnostic services centre hand therapy extensor tendons. This protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. Achilles tendon repair rehab protocol below we outline the steps that we have our patients take to recover from achilles tendon repair surgery. General guidelines patient will be in rigid splint in elbow extension for two weeks. Andrew green, md associate professor of orthopaedic. Accelerated rehabilitation following achilles tendon repair after acute rupture development of an evidencebased treatment protocol. Rehabilitation guidelines for lateral ankle reconstruction. Weightbearing has been shown in studies to improve strength of healing with no increase in rerupture rate just protect from any. The achilles is the largest tendon in the human body and transmits the powerful contractions of the calf muscles that are required for walking and running. Accelerated rehabilitation following achilles tendon repair. Achilles tendon rupture repair return to sport protocol. Achilles tendon repair rehabilitation postoperative guideline.
Triceps tendon repair procedure rehabilitation protocol phase 1. Reiterate tendon healing times, especially as the hand will be feeling a lot better now. Outcome of early active mobilization after extensor tendon repair. Flexor tendon repair zones 25 protocolbrigham and womens hospital phase i.
Rehabilitation guidelines for patellar tendon and quadriceps. This protocol provides you with general guidelines for the rehabilitation of the patient undergoing triceps tendon repair. At 23 weeks home estim unit if needed for quadriceps muscle reed. Rehabilitation guidelines for achilles tendon repair. Achilles tendon repair rehabilitation protocol this rehabilitation protocol was developed for patients who have had a repair of an acute achilles tendon rupture. Usually, the repair is done as an outpatient or overnight stay. As such, it should be stressed that this is only a protocol and should not be a substitute. Patient will be fitted with a hinged, limited rom brace lrom preoperatively. Patellar and quad tendon repair info boston sports medicine. The goal of the rehabilitation is to gradually regain motion in. Advise that tendon could still rupture or stretch if overused.
When they contract, they pull on the achilles tendon causing your foot to point down plantar flexionand helping you raise up on your toes. Brace locked at 30 degrees as specified by physician for weeks 36 physical therapy starts week 4. David gordon, consultant orthopaedic surgeon achilles tendon repair post operative accelerated rehabilitation protocol. Amol saxena, dpm, facfas debridement of achilles tendon. Afterwards, a knee immobilizer or hinged brace is often used to protect the repair. Please follow the protocol along with the instructions listed on the patients referral. Repair and rehabilitation of zone five flexor tendon injuries of the wrist. Rom should be measure in both open and closedchain methods.
There are actually three joints that make up the ankle complex. Weeks 0 to 4 weight bearing non weight bearing with crutcheswalker exercise no active plantarflexion active dorsiflexion to neutral at two weeks and beyond active inversioneversion within patient tolerance two weeks and beyond. Rehabilitation protocol for achilles tendon repair this protocol is intended to guide clinicians and patients through the postoperative course for an achilles tendon repair. Phase one maximum protection weeks 06 0 to 2 weeks brace locked in full extension for 6 weeks partial weight bearing for 2 weeks ice and modalities to reduce pain and inflammation aggressive patella mobility range of motion 0. Rehabilitation programme following patellar tendon repair dr justin roe au protocol prepared by catherine moore sports physiotherapist north sydney orthopaedic and sports medicine centre moore health, shop 2c780 bourke st redfern 2016 suite 2 the mater clinic, 3 gillies st wollstonecraft nsw 2065.
This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Treatment options for an achilles tendon rupture include surgical repair and conservative nonsurgical rehabilitation. Surgical repair of the achilles tendon offers a lower rerupture rate 04%, a greater chance of returning to sports, greater strength, and more endurance. Achilles tendon repair is performed after injury occurs to the achilles tendon. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. This study included thirteen patients with volar cut wrist injuries.
Internal tendon tension transmitted to the repair site with specific joint angles and external loads splinting configurationsexercise positions g. Distal biceps tendon repair rehabilitation protocol. It attaches the calf muscles soleus and gastrocnemius to the heel bone calcaneus. For best outcomes, the achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. Although the initial surgical repair is strong enough to permit unweighted ankle motion, it can take up to 6 months for a full return to activity. After quadriceps tendon repair the arlington group. This protocol provides you with general guidelines for initial stage and progression of rehabilitation.
This protocol was developed for patients who have had a primary repair of the. Flexor tendon repair therapy protocol 1 of 5 bart eastwood d. Mar 15, 2016 this protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. Hippocrates was the first to record an injury to the achilles tendon, while ambrose pare was the first to describe achilles tendon ruptures in 1575, and gustave paoaillon was the first to report operative repair of the tendon. An incision is made on the front of the knee, over the tendon. Achilles tendon rupture repair return to sport protocol keys for achilles tendon rehabilitation. Distal biceps tendon repair rehabilitation protocol the following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance. Patient fit with irom elbow brace, to be worn at all times except bathing. Achilles tendon surgical repair rehabilitation guidelines. However wound complcations such as wound breakdown or infection can occur and can be very serious. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation. The injury is often accompanied by an audible and palpable pop with limited ability to push off of the injured limb. Quadriceps and patella tendon repair rehabilitation protocol.
Debridement of achilles tendon post operative protocol total 6 weeks of immobilization nonweightbearing x 2 weeks weightbearing in boot x4 weeks until 6wks post surgery first postoperative follow up within 25 days after surgery nonweightbearing in cam boot for 2 weeks may cross train with stationary bike with heel on pedal. Baumbach, wolf mutschler, hans polzer munich university hospital, department of trauma surgery, ludwigmaximiliansuniversity, nussbaumstr. Dependent upon the patient and quality of the repair, weight bearing status postoperatively as well as the intensity and time frame of initiation of functional activities will vary. It is not intended to be a substitute for ones clinical decision making. Murphy, md board certified orthopedic surgeon specializing in sports medicine and arthroscopy 10475 centurion pkwy. The ideal is to achieve full symmetry in all 3 areas. Dorsal blocking splint w wrist in neutral, mcps at 50 flexion, ips in full extension. Repair and rehabilitation of zone five tendon injuries of the. Advice and exercises following your extensor diagnostic. Obviously, the choice between one protocol and another is a matter. Outcome of early active mobilization after extensor tendon. The achilles tendon is a strong tendon that connects the calf muscles to the heel.
Rehabilitation guidelines for achilles tendon repair uw health. Post repair therapy protocols page 1 of 10 l019d hand therapy protocols following are representative protocols for each of the three basic approaches to flexor tendon post repair management. It is by no means intended to be a substitute for ones clinical decisionmaking regarding the progression of a. As tolerated in cam walker boot with heel wedges in place first wedge removed at 4 weeks, second wedge removed at 6. Achilles tendon repair and rehabilitation clinical gate. The femur is the large bone in the thigh and attaches by ligaments and a capsule to the tibia, the large bone below the knee commonly referred to as the shin bone. Rehabilitation guidelines for achilles tendon repair the achilles tendon is the strongest and thickest tendon in the body. As such, it must be stressed that this is just a protocol and needs to not be a substitute for expert clinical decisionmaking regarding a patients development. Accelerated rehabilitation following achilles tendon. Physical therapy zones 25 flexor tendon repair protocol timelinesplint therapeutic exercise precautionsother week 3 may initiate serial static pip extension splints at night if needed. Accelerated achilles protocol time frame activity 02 weeks posterior slabsplint. Suite 224a blacksburg, va 24060 54055273 postoperative phase i 24 hours to 34 weeks goals fa br icati o nfcu s tmmm ilizati pli i nst ructi oinprom andptected arom i ncreased tendoexcursio ed ema co ntrl andsar ag ent independenceinhep precautions. Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row. If it does, rest the patient until pain level is clearly decreasing.
This rehabilitation program is designed to return the individual to their activities as quickly and. Rehabilitation protocol general principles this protocol for achilles tendon repair is designed to provide the rehabilitation professional with a general guideline for patient care with the alterg antigravity treadmill. Comparing three postoperative treatment protocols for extensor tendon repair in zones v and vi of the hand you will receive an email whenever this article is corrected, updated, or cited in the literature. Brace locked in full extension for 6 weeks partial weight bearing for 2 weeks ice and modalities to reduce pain and inflammation aggressive patella mobility drills range of motion 0 to 30knee flexion weeks 2 to 4. Rehabilitation guidelines for distal biceps tendon repair. Questions regarding the progress of any specific patient are encouraged, and should be. Achilles tendon repair postop rehabilitation protocol. Achilles repair rehab protocol formal rehabilitation typically begins four to six weeks postoperatively. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation of achilles tendon injury, diagnosis and treatment.