Heterotopic Ossification After an Achilles Tendon Rupture Cannot Be Prevented by Early Functional Rehabilitation: A Cohort Study

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Heterotopic Ossification After an Achilles Tendon Rupture Cannot Be Prevented by Early Functional Rehabilitation: A Cohort Study

Magnusson, S. Peter (författare): Univ Copenhagen, Denmark; Bispebjerg Hosp, Denmark

Agergaard, Anne-Sofie (författare): Univ Copenhagen, Denmark; Bispebjerg Hosp, Denmark

Couppe, Christian (författare): Univ Copenhagen, Denmark; Bispebjerg Hosp, Denmark

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Svensson, Rene B. (författare): Univ Copenhagen, Denmark

Warming, Susan (författare): Univ Copenhagen, Denmark; Bispebjerg Hosp, Denmark

Krogsgaard, Michael R. (författare): Bispebjerg and Frederiksberg Hosp, Denmark

Kjaer, Michael (författare): Univ Copenhagen, Denmark

Eliasson, Pernilla T. (författare): Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Univ Copenhagen, Denmark

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LIPPINCOTT WILLIAMS & WILKINS, 2020
2020
Engelska.
Ingår i: Clinical Orthopaedics and Related Research. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-921X .- 1528-1132. ; 478:5, s. 1101-1108

Relaterad länk:: https://liu.diva-por... (primary) (Raw object); visa fler...; https://urn.kb.se/re...; https://doi.org/10.1...; visa färre...

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Background Tendon loading might play a role in the development of heterotopic ossification after Achilles tendon ruptures. Early heavy loading on a healing tendon in animals has been shown to prolong the proinflammatory response, and inflammatory cells are thought to drive heterotopic ossification formation. Taken together, this suggests that early rehabilitation might influence heterotopic ossification development. Questions/purposes The purposes of this study were to investigate (1) whether the presence of heterotopic ossification after Achilles tendon ruptures influences clinical outcome and (2) whether early mobilization or weightbearing prevents the development of heterotopic ossification. Methods This was a retrospective analysis of 69 patients from a previous clinical trial. All patients were treated surgically, but with three different early rehabilitation protocols after surgery: late weightbearing and ankle immobilization, late weightbearing and ankle mobilization, and early weightbearing and ankle mobilization. Plain radiographs taken 2, 6, 12, 26, and 52 weeks postoperatively were analyzed for heterotopic ossification, which was detected in 19% of patients (13 of 69) at 52 weeks. Heterotopic ossification was measured, scored, and correlated to clinical outcomes; heel-raise index (HRI), ankle joint ROM, tendon strain, Achilles tendon rupture score (ATRS), and Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire scores at 26 and 52 weeks postoperatively. Results Heterotopic ossification had no adverse effects on patient-reported outcomes (ATRS or VISA-A), tendon strain, or ROM. In fact, patients with heterotopic ossification tended to have a better HRI at 52 weeks compared with patients without (mean difference 14% [95% CI -0.2 to 27]; p = 0.053). Neither the occurrence (heterotopic ossification/no heterotopic ossification) nor the heterotopic ossification severity (ossification score) differed between the three rehabilitation groups. Seventeen percent of the patients (four of 24) with early functional rehabilitation (early weightbearing and ankle joint mobilization exercise) had heterotopic ossification (score, 2-3) while late weightbearing and immobilization resulted in heterotopic ossification in 13% of the patients (score, 3-4). Conclusions Heterotopic ossification occurs relatively frequently after Achilles tendon ruptures but appears to have no adverse effects on functional outcomes. Furthermore, heterotopic ossification develops during the first 6 weeks after rupture, and weightbearing or ankle-joint mobilization does not prevent this from occurring.

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MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)

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Av författaren/redakt...: Magnusson, S. Pe ...; Agergaard, Anne- ...; Couppe, Christia ...; Svensson, Rene B ...; Warming, Susan; Krogsgaard, Mich ...; visa fler...; Kjaer, Michael; Eliasson, Pernil ...; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

Artiklar i publikationen: Clinical Orthopa ...

Av lärosätet: Linköpings universitet

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