Local experience of laboratory activities in a BS physical therapy course: integrating sEMG and kinematics technology with active learning across six cohorts

Introduction

Integrating technology and active learning methods into Laboratory activities would be a transformative educational experience to familiarize physical therapy (PT) students with STEM backgrounds and STEM-based new technologies. However, PT students struggle with technology and feel comfortable memorizing under expositive lectures. Thus, we described the difficulties, uncertainties, and advances observed by faculties on students and the perceptions about learning, satisfaction, and grades of students after implementing laboratory activities in a PT undergraduate course, which integrated surface-electromyography (sEMG) and kinematic technology combined with active learning methods.

Methods

Six cohorts of PT students (n = 482) of a second-year PT course were included. The course had expositive lectures and seven laboratory activities. Students interpreted the evidence and addressed different motor control problems related to daily life movements. The difficulties, uncertainties, and advances observed by faculties on students, as well as the students' perceptions about learning, satisfaction with the course activities, and grades of students, were described.

Results

The number of students indicating that the methodology was "always" or "almost always," promoting creative, analytical, or critical thinking was 70.5% [61.0-88.0%]. Satisfaction with the whole course was 97.0% [93.0-98.0%]. Laboratory grades were linearly associated to course grades with a regression coefficient of 0.53 and 0.43 R-squared (p < 0.001).

Conclusion

Integrating sEMG and kinematics technology with active learning into laboratory activities enhances students' engagement and understanding of human movement. This approach holds promises to improve teaching-learning processes, which were observed consistently across the cohorts of students.

Multiclass Support Vector Machine improves the Pivot-shift grading from Gerdy's acceleration resultant prior to the acute Anterior Cruciate Ligament surgery

INTRODUCTION

Rotatory laxity acceleration still lacks objective classification due to interval grading superposition, resulting in a biased pivot shift grading prior to the Anterior Cruciate Ligament (ACL) reconstruction. However, data analysis might help improve data grading in the operative room. Therefore, we described the improvement of the pivot-shift categorization in Gerdy's acceleration under anesthesia prior to ACL surgery using a support vector machine (SVM) classification, surgeon, and literature reference.

METHODS

Seventy-five patients (aged 30.3 ± 10.2 years, and IKDC 52.0 ± 16.5 points) with acute ACL rupture under anesthesia prior to ACL surgery were analyzed. Patients were graded with pivot-shift sign glide (+), clunk (++), and (+++) gross by senior orthopedic surgeons. At the same time, the tri-axial tibial plateau acceleration was measured. Categorical data were statistically described, and the accelerometry and categorical data were associated (α = 5%). A multiclass SVM kernel with the best accuracy trained by orthopedic surgeons and assisted from literature for missing data was compared with experienced surgeons and literature interval grading. The cubic SVM classifier achieved the best grading.

RESULTS

The intra-group proportions were different for each grading in the three compared strategies (p < 0.001). The inter-group proportions were different for all comparisons (p < 0.001). There were significant (p < 0.001) associations (Tau: 0.69, -0.28, and -0.50) between the surgeon and SVM, the surgeon and interval grading, and the interval and SVM, respectively.

CONCLUSION

The multiclass SVM classifier improves the acceleration categorization of the (+), (++), and (+++) pivot shift sign prior to the ACL surgery in agreement with surgeon criteria.

Biased instantaneous regional muscle activation maps: Embedded fuzzy topology and image feature analysis

The instantaneous spatial representation of electrical propagation produced by muscle contraction may introduce bias in surface electromyographical (sEMG) activation maps. Here, we described the effect of instantaneous spatial representation (sEMG segmentation) on embedded fuzzy topological polyhedrons and image features extracted from sEMG activation maps. We analyzed 73,008 topographic sEMG activation maps from seven healthy participants (age 21.4 ± 1.5 years and body mass 74.5 ± 8.5 kg) who performed submaximal isometric plantar flexions with 64 surface electrodes placed over the medial gastrocnemius muscle. Window lengths of 50, 100, 150, 250, 500, and 1,000 ms and overlap of 0, 25, 50, 75, and 90% to change sEMG map generation were tested in a factorial design (grid search). The Shannon entropy and volume of global embedded tri-dimensional geometries (polyhedron projections), and the Shannon entropy, location of the center (LoC), and image moments of maps were analyzed. The polyhedron volume increased when the overlap was <25% and >75%. Entropy decreased when the overlap was <25% and >75% and when the window length was <100 ms and >500 ms. The LoC in the x-axis, entropy, and the histogram moments of maps showed effects for overlap (p < 0.001), while the LoC in the y-axis and entropy showed effects for both overlap and window length (p < 0.001). In conclusion, the instantaneous sEMG maps are first affected by outer parameters of the overlap, followed by the length of the window. Thus, choosing the window length and overlap parameters can introduce bias in sEMG activation maps, resulting in distorted regional muscle activation.

Effects of Elbow Crutch Locomotion on Gluteus Medius Activation During Stair Ascending

Crutches can help with the locomotion of people with walking disorders or functional limitations. However, little is known about hip muscle activation during stair ascending using different crutch locomotion patterns in people without disorders and limitations. Thus, we determined the acute effects of elbow crutch locomotion on gluteus medius (GM) activity during stair ascending. This comparative analytic cross-sectional study enrolled ten healthy men (22.0 ± 0.47 years). Participants climbed up the stairs with elbow crutches using one or two crutches, with ipsilateral or contralateral use, and after loading or unloading a limb. EMG signals were recorded from anterior, middle, and posterior portions of the GM and compared between the crutch conditions. The Kruskal–Wallis test and Dunn’s multiple comparison test were performed (α = 5%). The activation of the GM increased with the ipsilateral use of crutches, with two crutches and three points, and when all the load depended only on one limb. GM activation decreased with contralateral use and in the unload limb. In conclusion, ascending stairs with elbow crutches alters the GM activation. The more critical factors were choosing the crutches’ lateral use, the number of crutches, and if the limb is loaded or unloaded while ascending the stairs. Our findings can be helpful to increase or decrease the GM activation for those who use or will use crutches.

Preseason multiple biomechanics testing and dimension reduction for injury risk surveillance in elite female soccer athletes: short-communication

Injury risk is regularly assessed during the preseason in susceptible populations like female soccer players. However, multiple outcomes (high-dimensional dataset) derived from multiple testing may make pattern recognition difficult. Thus, dimension reduction and clustering may be useful for improving injury surveillance when results of multiple assessments tools are available. Thus, we determined the influence of dimension reduction for pattern recognition followed by clustering on multiple biomechanical injury markers in elite female soccer players during preseason. We introduce the use of dimension reduction through linear principal component analysis (PCA), non-linear kernel principal component analysis (k-PCA), t-distributed stochastic neighbor embedding (t-sne), and uniform manifold approximation and projection (umap) for injury markers via grid search. Muscle strength, muscle function, jump technique and power, balance, muscle stiffness, exercise tolerance, and running performance were assessed in an elite female soccer team (n=21) prior to the competitive season. As a result, umap facilitated the injury pattern recognition compared to PCA, k-PCA, and t-sne. One of three patterns was related to a team subgroup with acceptable muscle conditions. In contrast, the other two patterns showed higher injury risk profiles. For our dataset, umap improved injury surveillance through multiple testing characteristics. Dimension reduction and clustering techniques present as useful strategies to analyze subgroups of female soccer players who have different risk profiles for injury.

Steadiness training improves the quadriceps strength and self-reported outcomes in persistent quadriceps weakness following nine months of anterior cruciate ligament reconstruction and failed conventional physiotherapy

Background Persistent quadriceps weakness may occur after anterior cruciate ligament reconstruction, limiting the strength gain. However, steadiness strengthening might change the inability to gain strength. Hence, we determined whether strength training with force steadiness and visual biofeedback can improve knee quadriceps torque, self-reported pain and knee stability in patients with persistent quadriceps weakness after knee anterior cruciate ligament reconstruction. Methods Twenty-five patients (aged 43.7 ± 12.2 years) with persistent quadriceps weakness following knee anterior cruciate ligament reconstruction and 34-weeks of physiotherapy performed unilateral strength training for both lower limbs. Four-weeks of conventional physiotherapy at week-30 were given, confirming the inability to gain torque. Then, steadiness training (isometric knee extension with visual biofeedback) was given for 7-weeks. Knee quadriceps peak torque, strength improvement, determination of responders to the intervention, coherence of strength gain between limbs, and self-reported outcomes (pain and knee stability) were obtained. Descriptive statistics and data inference using mixed-ANOVA, McNemar test, and χ² test were described. Findings Quadriceps torque in the reconstructed knee improved (98.2 ± 47.2-155.2 ± 78.9 Nm; p = 0.031) for most patients (84%). Nevertheless, the torque was lower than the healthy side maintaining asymmetry (155.2 ± 78.9 vs. 209.5 ± 101.8 Nm; p = 0.026). There was high (20%) and medium coherence (80%) between limbs. Knee stability and pain improved in 72% of the patients (p < 0.001). Interpretations Steadiness training after anterior cruciate ligament reconstruction followed 9 months of surgery and failed conventional physiotherapy, improves the persistent weakness and self-reported outcomes, but gain strength was dissimilar between limbs.

Do the heel-rise test and isometric strength improve after Achilles tendon repair using Dresden technique?

BACKGROUND

Achilles' tendon ruptures result in impaired plantar flexion strength and endurance. It is interesting to know the plantar flexion strength, the number of heel-rise repetitions, and the maximal calf circumference following Achilles' tendon ruptures repair.

METHODS

Both the injured and non-injured legs of thirty male patients with Achilles' tendon ruptures treated with the percutaneous Dresden technique were compared with the ankle function of 30 healthy participants. Rehabilitation involved partial weight-bearing for three weeks and then increased to full weight-bearing and ankle exercises.

RESULTS

The injured legs had weaker plantar flexion strength (1.64 ± 0.17 Nm/kg) compared with the non-injured legs (1.91 ± 0.24 Nm/kg; p = 0.002) and the healthy participants' legs (1.93 ± 0.32 Nm/kg; p < 0.001). The non-injured leg had greater ability in doing heel-rise repetitions (39.4 ± 6.1 rep.) compared with the injured legs (37.2 ± 5.7 rep.; p < 0.023) and the healthy participants' legs (31.0 ± 13.0 rep.; p < 0.001).

CONCLUSIONS

The injured leg had not recovered full isometric strength but had improved heel-rise repetition.

Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury

Purpose

The knee stiffness acquired following an Anterior Cruciate Ligament (ACL) injury might affect clinical knee tests, i.e., the pivot-shift maneuver. In contrast, the motor effects of spinal anesthesia could favor the identification of rotatory knee deficiencies prior to ACL reconstruction. Hence, we hypothesized that the intra-operative pivot-shift maneuver under spinal anesthesia generates more acceleration in the lateral tibial plateau of patients with an injured ACL than without.

Methods

Seventy patients with unilateral and acute ACL rupture (62 men and 8 women, IKDC of 55.1 ± 13.8 pts) were assessed using the pivot-shift maneuver before and after receiving spinal anesthesia. A triaxial accelerometer was attached to the skin between Gerdys’ tubercle and the anterior tuberosity to measure the subluxation and reduction phases. Mixed ANOVA and multiple comparisons were performed considering the anesthesia and leg as factors (alpha = 5%).

Results

We found a higher acceleration in the injured leg measured under anesthesia compared to without anesthesia (5.12 ± 1.56 m.s^− 2 vs. 2.73 ± 1.19 m.s^− 2, p < 0.001), and compared to the non-injured leg (5.12 ± 1.56 m.s^− 2 vs. 3.45 ± 1.35 m.s^− 2, p < 0.001). There was a presence of significant interaction between leg and anesthesia conditions (p < 0.001).

Conclusions

The pivot-shift maneuver performed under anesthesia identifies better rotatory instability than without anesthesia because testing the pivot-shift without anesthesia underestimates the rotatory subluxation of the knee by an increased knee stiffness. Thus, testing under anesthesia provides a unique opportunity to determine the rotational instability prior to ACL reconstruction.

Video-based biomechanical analysis of an unexpected Achilles tendon rupture in an Olympic sprinter

We used image-processing techniques to determine the moment (i.e., image frame) of the Achilles tendon (AT) rupture in an Olympic sprinter. This report may be unique due to the difficulty in conducting motion capture analyses during injury events. Our report includes one female Olympic sprinter, 29 years old (body mass: 56 kg, height: 1.68 m, and body mass index: 19.8 kg/m²) with a high-competitive profile history (2008 and 2012 Olympic Games participation; South American record holder in 100- and 200-m; Pan-American gold medalist in 200-m and 4 × 100-m relay) who suffered a complete AT rupture in the left leg while exercising in the final phase of rehabilitation following an Achilles tendinopathy in the contralateral limb. The greater dorsiflexion found at the moment of the injury and the delayed control of heel position indicated the presence of uncontrolled dorsiflexion, which potentially generated excessive eccentric stress over the tendon and, thus, the AT rupture. Here we discuss the relevance of lower leg alignment, the movements' characteristics, and the history of Achilles tendinopathy in the contralateral leg on the occurrence of the AT rupture.

Relationship between Skin Temperature, Electrical Manifestations of Muscle Fatigue, and Exercise-Induced Delayed Onset Muscle Soreness for Dynamic Contractions: A Preliminary Study

Delayed onset muscle soreness (DOMS) indicates the presence of muscle damage and impairs force production and control. Monitorization of DOMS is useful to improving recovery intervention plans. The magnitude of DOMS may relate to muscle fatigue, which can be monitored by surface electromyography (EMG). Additionally, growing interest has been expressed in determining whether the skin temperature over a muscle group during exercise to fatigue could be a non-invasive marker for DOMS. Here we determine whether skin temperature and manifestations of muscle fatigue during exercise are correlated and can predict DOMS after concentric-eccentric bicep curl exercises. We tested 10 young adults who performed concentric-eccentric bicep curl exercises to induce muscle damage in the biceps brachialis to investigate the relationship between skin temperature and fatigue during exercise and DOMS after exercise. Muscle activation and skin temperature were recorded during exercise. DOMS was evaluated 24 h after exercise. Data analysis was performed using Bayesian regression models with regularizing priors. We found significant muscle fatigue and an increase in skin temperature during exercise. DOMS was observed 24 h after exercise. The regression models showed no correlation of changes in skin temperature and muscle fatigue during exercise with DOMS 24 h after exercise. In conclusion, our preliminary results do not support a relationship between skin temperature measured during exercise and either muscle fatigue during exercise or the ability to predict DOMS 24 h after exercise.

Intrasession Real-time Ultrasonography Feedback Improves the Quality of Transverse Abdominis Contraction

OBJECTIVE

The purpose of this study was to compare changes in thickness of the transverse abdominis during performance of the hollowing exercise guided by feedback using ultrasonography images together with verbal guidance and using verbal guidance alone. We also determined the minimal detectable change and agreement between normalized pressures and muscle thickness.

METHODS

Twenty participants without lumbar pain performed the hollowing exercises with or without ultrasonography feedback: 7 men and 13 women, mean (SD) age = 25 (5) years, height = 166 (10) cm, body mass = 64 (6) kg, body mass index = 22.2 (5.8) kg/m². The thickness of the transverse abdominis was quantified during the exercise using musculoskeletal ultrasonography. Basal and 3 repetitions guided by an evaluator were performed. Pressure was determined using a lumbar cushion. Data were compared with a mixed-model analysis of variance and Bonferroni post hoc test (P < .05). Minimal detectable changes were identified and Bland-Altman analysis performed considering normalized thickness and pressure.

RESULTS

Ultrasonography feedback resulted in larger thickness changes (P < .05). The lowest minimal detectable changes were achieved using ultrasonography feedback. Nonagreement was found between normalized thickness and pressure.

CONCLUSION

Contraction of the transverse abdominis is improved using real-time ultrasonography together with verbal feedback. Low changes in muscle contraction estimated by thickness showed nonagreement with a pressure cushion.

Winter School on sEMG Signal Processing: An Initiative to Reduce Educational Gaps and to Promote the Engagement of Physiotherapists and Movement Scientists With Science

The application of surface electromyography (sEMG) in neurology is sometimes limited by a scientific background in the use of sEMG. Students frequently use sEMG only when developing their graduate studies. To reduce these barriers, we promoted a free Winter School on sEMG to Latin American students. The school was a 3-day event with theoretical classes and computer programming in Matlab. Lectures were delivered in Portuguese and Spanish to 50 participants. All lectures were recorded and made available on YouTube®. After the School, participants completed a written exam to receive a certificate. The written exam revealed the average effectiveness of 71 ± 20% in the comprehension of topics addressed during the school. Participants rated the School as “excellent” and considered the event as having changed their thoughts about the use of sEMG. Limited mathematical skills or background were the main barriers identified to follow the lectures and to make use of sEMG. We conclude that the Winter School had a positive impact on participant's formation, especially by showing them the importance of continuous involvement with the concepts related to sEMG to become proficient in its use. From the participant's point of view, the activity was excellent and the follow up of the school on YouTube® suggests that combining face-to-face activities followed by the online availability of lectures is a valid strategy to reinforce the learning process and to reduce barriers in the use of sEMG. Whether similar results would be achieved for a paid registration event in an economically developing region, still requires further investigation.

Impact of Visual Biofeedback of Trunk Sway Smoothness on Motor Learning during Unipedal Stance

The assessment of trunk sway smoothness using an accelerometer sensor embedded in a smartphone could be a biomarker for tracking motor learning. This study aimed to determine the reliability of trunk sway smoothness and the effect of visual biofeedback of sway smoothness on motor learning in healthy people during unipedal stance training using an iPhone 5 measurement system. In the first experiment, trunk sway smoothness in the reliability group (n = 11) was assessed on two days, separated by one week. In the second, the biofeedback group (n = 12) and no-biofeedback group (n = 12) were compared during 7 days of unipedal stance test training and one more day of retention (without biofeedback). The intraclass correlation coefficient score 0.98 (0.93–0.99) showed that this method has excellent test–retest reliability. Based on the power law of practice, the biofeedback group showed greater improvement during training days (p = 0.003). Two-way mixed analysis of variance indicates a significant difference between groups (p < 0.001) and between days (p < 0.001), as well as significant interaction (p < 0.001). Post hoc analysis shows better performance in the biofeedback group from training days 2 and 7, as well as on the retention day (p < 0.001). Motor learning objectification through visual biofeedback of trunk sway smoothness enhances postural control learning and is useful and reliable for assessing motor learning.

Absolute reliability and concurrent validity of a novel electromechanical pulley dynamometer for measuring shoulder rotation isometric strength in asymptomatic subjects. Study conducted at Pontificia Universidad Católica, Santiago, Chile

OBJECTIVE

To estimate the test-retest reliability of measurements in shoulder internal and external rotators' isometric peak torque using a new dynamometer, and to compare it with isokinetic dynamometer.

METHODS

The validity study was conducted in September-October 2016 at Pontificia Universidad Catolica de Chile and the Clinica Las Condes, Santiago, Chile. It comprised of asymptomatic university students who were randomly tested twice within a two-week period while in a supine position at 90° of shoulder abduction, using the novel functional electromechanical pulley dynamometer. Concurrent validity was assessed through comparing the values with the gold standard isokinetic dynamometer in the same position. SPSS 17 was used for data analysis.

RESULTS

Of the 24 subjects, 5(21%) were males and 19(79%) were females. The overall mean age was 23.1±2.2 years, body mass index 23.6±2.13 kg/m2 and Shoulder Pain and Disability Index score was 3.9±6.4. There was no statistically non-significant difference in terms of test-retest trials and between the devices (p>0.05). Absolute reliability was 24.3% for internal rotation and 27.9% for external rotation. Both dynamometer systems were very highly correlated for internal rotators peak torque (0.93) and highly correlated for external rotators peak torque (0.84).

CONCLUSIONS

Compared to the gold standard, the new device was found to be a valid instrument in measuring maximal voluntary isometric peak torque in internal and external rotation.

Use of accelerometers for automatic regional chest movement recognition during tidal breathing in healthy subjects

Recognition of breathing patterns helps clinicians to understand acute and chronic adaptations during exercise and pathological conditions. Wearable technologies combined with a proper data analysis provide a low cost option to monitor chest and abdominal wall movements. Here we set out to determine the feasibility of using accelerometry and machine learning to detect chest-abdominal wall movement patterns during tidal breathing. Furthermore, we determined the accelerometer positions included in the clusters, considering principal component domains. Eleven healthy participants (age: 21 ± 0.2 y, BMI: 23.4 ± 0.7 kg/m², FEV₁: 4.1 ± 0.3 L, VO₂: 4.6 ± 0.2 mL/min kg) were included in this cross-sectional study. Spirometry and ergospirometry assessments were performed with participants seated with 13 accelerometers placed over the thorax. Data collection lasted 10  min. Following signal pre-processing, principal components and clustering analyses were performed. The Euclidean distances in respect to centroids were compared between the clusters (p < 0.05), identifying two clusters (p < 0.001). The first cluster included sensors located at the right and left second rib midline, body of sternum, left fourth rib midline, right and left second thoracic vertebra midline, and fifth thoracic vertebra. The second cluster included sensors at the fourth right rib midline, right and left seventh ribs, abdomen at linea alba, and right and left tenth thoracic vertebra midline. Costal-superior and costal-abdominal patterns were also recognized. We conclude that accelerometers placed on the chest and abdominal wall permit the identification of two clusters of movements regarding respiration biomechanics.

Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement

BACKGROUND

The Hintegra® arthroplasty provides inversion-eversion stability, permits axial rotation, ankle flexion-extension, and improvements of the gait patterns are expected up to 12 months of rehabilitation. However, sensorimotor impairments are observed in ankle flexors/extensors muscles after rehabilitation, with potential negative effects on locomotion. Here we determined the timing and amplitude of co-activation of the tibialis anterior and medial gastrocnemius muscles during gait by assessing non-operated and operated legs of patients with total ankle replacement, 5 years after surgery.

METHODS

Twenty-nine patients (age: 58 [5.5] years, height: 156.4 [6.5] cm, body mass: 72.9 [6.5] kg, 10 men, and 19 women) that underwent Hintegra® ankle arthroplasty were included. Inclusion criteria included 5 years prosthesis survivorship. The onset and offset of muscle activation (timing), as well as the amplitude of activation, were determined during barefoot walking at self-selected speed by surface electromyography. The timing, percentage, and index of co-activation between the tibialis anterior and medial gastrocnemius were quantified and compared between non-operated and operated legs.

FINDINGS

The operated leg showed higher co-activation index and temporal overlapping between tibialis anterior and medial gastrocnemius during gait (p < 0.001).

INTERPRETATION

The neuromuscular changes developed during the process of degeneration do not appear to be restored 5 years following arthroplasty. The insertion of an ankle implant may restore anatomy and alignment but neuromuscular adaptations to degeneration are not corrected by 5 years following joint replacement.

Absolute Reliability and Concurrent Validity of Hand Held Dynamometry and Isokinetic Dynamometry in the Hip, Knee and Ankle Joint: Systematic Review and Meta-analysis

The purpose of the study is to establish absolute reliability and concurrent validity between hand-held dynamometers (HHDs) and isokinetic dynamometers (IDs) in lower extremity peak torque assessment. Medline, Embase, CINAHL databases were searched for studies related to psychometric properties in muscle dynamometry. Studies considering standard error of measurement SEM (%) or limit of agreement LOA (%) expressed as percentage of the mean, were considered to establish absolute reliability while studies using intra-class correlation coefficient (ICC) were considered to establish concurrent validity between dynamometers. In total, 17 studies were included in the meta-analysis. The COSMIN checklist classified them between fair and poor. Using HHDs, knee extension LOA (%) was 33.59%, 95% confidence interval (CI) 23.91 to 43.26 and ankle plantar flexion LOA (%) was 48.87%, CI 35.19 to 62.56. Using IDs, hip adduction and extension; knee flexion and extension; and ankle dorsiflexion showed LOA (%) under 15%. Lower hip, knee, and ankle LOA (%) were obtained using an ID compared to HHD. ICC between devices ranged between 0.62, CI (0.37 to 0.87) for ankle dorsiflexion to 0.94, IC (0.91to 0.98) for hip adduction. Very high correlation were found for hip adductors and hip flexors and moderate correlations for knee flexors/extensors and ankle plantar/dorsiflexors.

Prospective randomized clinical trial of aggressive rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique

BACKGROUND

Rupture of the Achilles tendon is a common injury during working years. Aggressive rehabilitation may provide better outcomes, but also a greater chance of re-rupture.

OBJECTIVE

To determine if aggressive rehabilitation has better clinical outcomes for Achilles tendon function, Triceps surae function, one-leg heel rise capacity and lower complication rate during twelve weeks after percutaneous Achilles tendon repair compared to conventional rehabilitation.

DESIGN

Randomized controlled trial.

METHOD

Thirty-nine patients were prospectively randomized. The aggressive group (n=20, 41.4 ± 8.3 years) received rehabilitation from the first day after surgery. The conventional group (n=19, 41.7 ± 10.7 years) rested for 28 days, before rehabilitation started. The statistical parameters were the Achilles tendon rupture score (ATRS), verbal pain scale, time to return to work, pain medication consumption, Achilles tendon strength, dorsiflexion range of motion (RoM), injured-leg calf circumference, calf circumference difference, one-leg heel rise repetition and difference, re-rupture rate, strength deficit rate, and other complication rates. Mixed-ANOVA and Bonferroni's post hoc test were performed for multiple comparisons. Student's t-test was performed for parameters measured on the 12th week.

RESULTS

The aggressive group with respect to the conventional group had a higher ATRS; lower verbal pain score; lower pain medication consumption; early return to work; higher Achilles tendon strength; higher one-leg heel rise repetitions; and lower one-leg heel rise difference. The re-rupture rate was 5% and 5%, the strength deficit rate was 42% and 5%, and other complications rate was 11% and 15% in the conventional and aggressive group, respectively.

CONCLUSION

Patients with Dresden repair and aggressive rehabilitation have better clinical outcomes, Achilles tendon function and one-leg heel rise capacity without increasing the postoperative complications rate after 12 weeks compared to rehabilitation with immobilization and non-weight-bearing during the first 28 days after surgery.