scar mobilization and friction massage) to decrease fibrosis. 2022 Aug 19;2022:2363230. doi: 10.1155/2022/2363230. Rerupture after Achilles repair is reported at about 2-12%, with no statistical difference reported between open, percutaneous, augmented, or closed treatment methods [1-4, 7, 9, 16].Open rerupture is an exceedingly rare complication and has only been described a handful of times [17-19].This report is the first case that we are aware of described in the literature of an . 4d1olrz?+Vg.TxH38@ g%L Higher level proprioception Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? PMC Open chain strength exercises for quads, hamstrings, glutes hip flexors. It arises near the middle of the calf and rotates approximately 90 degrees laterally during its course to insert on the posterior aspect of the calcaneal tuberosity [ 1, 2 ]. Discussion. Achilles Tendon Repair; ACL Reconstruction: Quadriceps Tendon Autograft; Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. Federal government websites often end in .gov or .mil. Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. Cardiovascular: stationary bike, StairMaster, swimming. The Alfredson Protocol is an exercise program for people with Achilles tendonitis ( tendinopathy ). Begin physio guided active range of motion ankle exercises from week 3-4. Treatment of acute Achilles tendon rupture - a multicentre, non Achilles Tendon Repair Surgery | Johns Hopkins Medicine An Achilles tendon repair surgery is a scheduled outpatient procedure done in an operating room located in a hospital or surgery center. leg jumps, skipping). . Impact control exercises beginning with two feet to two feet, progressing from one foot to the other, and then one foot to the same foot. Gentle calf stretching with a towel (not body weight). Effect of Transdermal Fentanyl Patch Combined with Enhanced Recovery after Surgery on the Curative Effect and Analgesic Effect of Liver Cancer. -. (50% BW) by Begin gait and ankle proprioception retraining. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 5 0 R/Group<>/Tabs/S/StructParents 1>> 2021 May 28;18:112-116. doi: 10.1016/j.reth.2021.05.002. The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. high load ankle, knee, hip Keywords: Mosconi M, Pasta G, Annunziata S, Guerrieri V, Ghiara M, Perelli S, Torriani C, Grassi FA, Jannelli E. Diagnostics (Basel). Functional movements (squats, step backs, lunges). 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. 8]z].U3wKI2 Level of evidence: hYmo6+DU f[j;;4vv+yw=lrD Epub 2018 Jan 8. This article describes a high-quality accelerated functional rehabilitation program that begins with early diagnosis and appropriate patient selection to allow initiation of the nonoperative protocol. Achilles Tendon Repair Rehab Protocol - manhattansportsdoc.com Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. 2014 Nov;45(11):1782-90 %PDF-1.7 surgeon and physio. Pain-free isometric ankle inversion, eversion, DF and submaximal PF. 4 0 obj ?h{vV4ECHD+A?E_Q-9U1DJY;p9 I* XX%|EjbwJH(g0Nf5.I ;v$c7H(d a_2d6QN&m 1. The https:// ensures that you are connecting to the Unauthorized use of these marks is strictly prohibited. PDF ACHILLES RUPTURE: OPERATIVE PROTOCOL - South Bend Orthopaedic Associates The Alfredson Protocol for Achilles Tendonitis - Verywell Health Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. After the Achilles tendon rupture repaired , patients were randomly divided into 2 groups, and the rehabilitation protocol was traditional rehabilitation protocol and accelerated rehabilitation protocol under ultrasonic monitoring , respectively, to study the difference in efficacy between the groups. 3 0 obj Keywords: Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol, Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet], Centre for Reviews and Dissemination (UK). Tendon pathology can be a result of intrinsic and extrinsic factors.1 Intrinsic factors include: 1) Forces through the tendon; running and jumping forces have been estimated at 5000N. bearing transitioning towards full weightbearing. Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. x\*"S&Rd9l)+%\hwMROw3$\Z1~v/^x|m],^}3fdY7iTe*)XU6ugshO_KQ`F5vYU? Close suggestions Search Search. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Accelerated rehabilitation following Achilles tendon repair after acute Slowly wean from boot. Achilles Tendon Repair Rehabilitation Protocol Phase I (surgery to 2 weeks after): Splint/Boot: Locked 20-30 degree plantarflexion for two weeks Weight-bearing: Touchdown weight-bearing (TDWB) with crutches Cardiovascular: Upper body circuit training Patient Precautions: Keep elevated. The Achilles tendon gives your leg strength to walk, run and jump. /n%^xij_2]!J] n >!UGld With!weighted!resisted . 2018 Mar;26(3):846-853. doi: 10.1007/s00167-015-3795-1. `p19~%t?JGw]Sv+[ ]RDir)A) '$M*0 eC5 7<81$^;c! Normal gait mechanics without the boot on all surfaces. Accelerated Rehab Program | Mr Daniel Goldbloom | Melbourne <> Operative versus non-operative treatment of acute Achilles tendon ruptures: a multi-center randomized trial using accelerated functional rehabilitation. 2020-2023 Mr Daniel Goldbloom | Privacy Policy | Disclaimer | Website design: Berwick - St John of God Consulting Suites. CAMBOOT with 10mm heel lift or VACOPED at (1) with flat sole for 4th week View a complete list of our locations and hours. 2017 Mar;137(3):333-340. doi: 10.1007/s00402-017-2627-9. Design of a randomized controlled trial. 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Hi folks, I am in week three post full Achilles rupture repair surgery. It is rare to have this procedure immediately after going to the emergency room for an injury. % Treatment of acute Achilles tendon rupture in Scandinavia does not adhere to evidence-based guidelines: a cross-sectional questionnaire-based study of 138 departments . An Achilles tendon rupture surgery reconnects the ends of the torn tendon. Begin standing calf stretch at 5 weeks (knee flexed and extended) Continue eversion, inversion and plantar flexion isometrics with resistance bands. stream Foot Ankle Spec. etc until cleared by Achilles tendon rupture is a common sports injury encountered in younger populations. Functional Rehabilitation for Nonsurgical Treatment of Acute Achilles Moderate load close/open chain calf strengthening to Postoperative rehabilitation protocols for Achilles tendon ruptures: a In addition, surgical repair involves, but is not limited to, an increased risk of infection, adhesions and disturbed skin sensibility with a pooled relative risk of 10.6 (95% CI; 4.8;23.3) as . Accelerated rehab protocol without surgery. The Achilles Tendon is the strong fibrous band that attaches the calf muscles to the calcaneus bone. Clipboard, Search History, and several other advanced features are temporarily unavailable. : MOFL?Wo(H&dxl. Tendon is a specialized tissue mainly composed of collagen extracellular matrix (ECM), transmitting forces from muscle to bone [1].Tendon injury accounts for a large proportion of musculoskeletal system disorders and poses a substantial burden on human health [2].Therapeutic interventions including surgery, drug, physical therapy and rehabilitation are used for tendon repair [3]. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. 1 0 obj The guiding principle for this rehabilitation protocol is early ankle motion, since it is believed to be the main reason why surgically treated Achilles tendon ruptures show a lesser rate of recurrence than those treated conservatively with a period of immobilization. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. PDF Non-Operative Treatment of Achilles Tendon Ruptures Phase 1 Maximum Immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results. eCollection 2021 Dec. Hidd SMCM, Tim CR, Dutra EF Jr, Maia Filho ALM, Assis L, Ferreira RS Jr, Barraviera B, Silva JF, Amaral MM. Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Knee Surg Sports Traumatol Arthrosc. <>/F 4/A<>/StructParent 0>> Zhang Z, Li Y, Zhang T, Shi M, Song X, Yang S, Liu H, Zhang M, Cui Q, Li Z. 1,2 These reviews and other systematic reviews consistently show a slightly lower incidence of re-rupture with operative treatment, which is . 2022 Jul 25;2022:9722458. doi: 10.1155/2022/9722458. endobj 3 What to Wear You can wear anything comfortable for your surgery appointment. It is important to evaluate whether early functional weight-bearing . Healing time clock restarts from day of surgery rather than day of injury 2022 Jul 29;12(8):1824. doi: 10.3390/diagnostics12081824. but an accelerated rehabilitation program should be accompanied by good results. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. 179 0 obj <> endobj Consequently, physicians may have reservations about adopting functional rehabilitation. ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy . 1995 Jan;98 (1):21-32 eCollection 2021. Strengthening (can be performed After the second postoperative week controlled ankle mobilization by free. [1] [2] Achilles tendinopathy has a detrimental effect on physical and mental well-being [3] [4]. Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair. Careers. government site. Goals: PT appointments are once every one to two weeks. q{b7\68wbZaX?MN3 ,iFaI!_>bT=BL~>k9Z'V>Y'Zo5M:Bt>Oby^|pRh/0UhclP"t~** 0! Clinical, Ultrasonographic, and Elastographic Comparison. building to The achilles tendon accounts for 20% of all large tendon injuries 1 with an estimated incidence ranging from 11 to 37 per 100,000. <> 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. ,8vue6Tq]6u06glk+zBE)wY4DNmJM4Y >I>UB5|g`dd?#ap_N#r*cCQm5&tcH_~vw~DXOI)J,!u Good control and no pain with functional movements, including step-up/down, squats and lunges. II. Active ROM between 5 degrees of DF and 40 degrees of PF. Before Physiotherapy Tailored and monitored by physio, Achilles Tendon Rupture Non-operative treatment rehabilitation guidelines, Achilles Tendon Rupture Operative treatment rehabilitation guidelines, Achilles Tendon Rupture Rehabilitation Videos, Big Toe (Hallux) 1st MTP Joint Fusion Surgery, General Information about Foot and Ankle Arthroscopy, General Information Injuries and Fractures, National Guidance Documents for Foot Surgery, Rest, recovery and mobilise non-weight bearing safely on crutches, Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed), Can carefully shower with waterproof cover over plaster cast/boot, Confidently weight bearing as pain allows using the crutches, Begin early, supervised, gentle ankle plantarflexion exercises, Maintain core, upper limb, hip, and knee strength, Rigid walking boot with foot pointing downwards with wedges inside boot, Can shower out of boot as long as very careful not to stand/stumble on foot, otherwise leave boot on with waterproof covering, Can weight-bear with crutches as discomfort allows in boot, Maintain spinal/hip/knee/toe range of movement, Can remove boot for exercises to gently actively plantarflex foot from position in boot to full range plantarflexion, Can dorsiflex back to position in the boot but not beyond, Progress to fully weight bearing but maintain use of crutches for balance if needed, Active ankle movement through available range of plantarflexion from position foot held in boot, Regain full inversion and eversion in available plantarflexion range, Aim for ankle plantigrade/foot flat by6-8 weeks in boot, Rigid walking boot with wedges being removed weekly to plantigrade position, Can remove one wedge per week until foot flat in the boot, Can perform active resisted plantarflexion, eversion and inversion with theraband, Can actively dorsiflex foot ONLY to position allowed by wedges in boot, No knee hyperextension to compensate for lack of ankle dorsiflexion, Aim to remove boot by weaning out by 12 weeks, Increase ankle and lower limb muscle strength, Boot with ankle plantigrade/ foot flat on the ground, Shower carefully so as not to stumble/forcefully dorsiflex ankle. 2 0 obj Objectives To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. National Library of Medicine Hi folks, I am in week three post full Achilles rupture repair surgery. A rupture of the Achilles Tendon (ATR) is a common pathology being the most commonly ruptured tendon in the human body. <>>> of direction, jumping and transmitted securely. SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Epub 2017 Jan 17. A LOCATION OF STONY BROOK ORTHOPAEDIC ASSOCIATES. jumping, running. Surgery is only the beginning of a long rehabilitation period. Normalize gait on all surfaces without boot or heel lift. The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. %PDF-1.7 weight Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. 24 staples. It is recommended that clinicians collaborate ^sR**aX^IZ9(cxq+{R r? Achilles tendon repair - Physiopedia In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment . basketball, tennis shots from standing start, contralateral 3. !.XyR-Kd-+"v+l3,~l|LR {Z^R}TTKS`p*9szqAdJAs2QGE6pzHf)'a n7=pMi-Sn3r7$5B"yUMQy^&hkj)V&a55JZp5JSb^]"37H919=N]?&h6.M{Af[Uf`0R;DW x^Q^5fu;%)Ptu$DtqEHg 2 0 obj Several common injuries can make your Achilles tendon painful or prevent it from working well. Our rehab protocols outline timing, precautions and progression criteria for returning to activity. kicking small. Place heel raises (1-2cm) in shoes to take some of the pressure off the Achilles tendon. Careers. TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol Time Frame Activity 0-2 weeks Posterior slab/splint; non-weight-bearing with crutches: immed. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. -, Unfallchirurg. It is found at the back of the lower leg, just above the heel bone. PDF ACCELERATED ACHILLES PROTOCOL - Indiana Total Therapy PDF Rehabilitation Guidelines for Achilles Tendon Repair - UW Health Rehabilitation Protocols | Ohio State College of Medicine Patient Information > Achilles Tendon Ruptures - BOFAS 1 0 obj . Methods: hb```>VNAd`0p`8pLYY[R'}500Tttt40( C1C(?4 PDF Non-Operative Treatment of Achilles Tendon Rupture <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> MRI studies may be indicated for surgical management of chronic injuries. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. In revision cases or when the tendon was damaged before the rupture, the tendon may need to be reconstructed using a graft from another tendon in your body. 2011 Dec;17(4):211-7 Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW. Disadvantages. Static balance exercises (begin in two-foot stance, then two-foot stance on balance board and gradually progress to single-leg stance). The .gov means its official. The Achilles tendon is a strong, fibrous cord in the lower leg. Achilles tendon rupture is a clinical diagnosis. Continue active resisted theraband exercises; plantarflex through full range, dorsiflexion to a natural plantigrade position, push no further. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Before PDF Non%operative!Treatment!for!Achilles!Tendon!Ruptures! Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Surgery is only the beginning of a long rehabilitation period. VQ4 L}3Sz~zzDM>{z?NO?UI(/oO=:0QI]WrDctQa4TxR6=&eA>F2z>'%62p2{c86Y82b%q}`D U4x$!fGjGg$grJ,l6hqs&Sn5?1qX:{6G|8(?Mu83V\kZO._C9=7R4z-XW3"tcFWPoJ^&K.HfZ5E.LJSe=jC7S'r++@7Tka'k{e1u_X\W{Rv3x:gj. Y!_x"o7/_"H4IE(:}/1 Achilles Tendon Rupture - Non-operative treatment rehabilitation guidelines 0-2 WEEKS REST (PHASE 1) Goals Rest, recovery and mobilise non-weight bearing safely on crutches Immobilisation Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed) Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-development of an evidence-based treatment protocol. Bethesda, MD 20894, Web Policies Normalize gait on level surfaces without boot or heel lift. 3,10,13,25 Historically, surgical repair of Achilles tendon rupture was thought to decrease the risk of re-rupture substantially. CAMBOOT with no heel lift or VACOPED at (0) with flat sole. Multi-plane proprioceptive exercises single-leg stance. 8600 Rockville Pike Acute Achilles Tendon Rupture Repair Rehab The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. This protocol was updated and reviewed by Dr. Devries and Dr. Scharer of BayCare Foot & Ankle Center and by Jessica Sigl, DPT on . Progression of calf stretching past plantar grade. group 2-4 weeks Aircast walking boot with 2-cm heel lift* Protected weight-bearing with crutches Graduated!resistanceexercises! Movement control exercises beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities. 0_'|,t0:!: . ^Fz,l6N}{D6Y?TP),#uz/i3F~bHG(BQ" =+Q%90Z6U='-rj\Ig pV.4FqW%W)53s^#D3 a`CN3=z[lmOgEA5CWwpLz9r4-+94Is9>}n-9k=n6R LAJxeF$ylM>MY@0vFEviCM ml@5s? PDF TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol An official website of the United States government. % Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. eCollection 2022. Injury. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? <> 1 0 obj Must be a complete, mid-substance Achilles tendon rupture & not a tendon avulsion from the calcaneus or gastroc/soleus. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. Metz R, Kerkhoffs GM, Verleisdonk EJ, van der Heijden GJ. The acute rupture of the Achilles tendon is a protracted injury. outcome drills ie. Achilles Tendon rupture: Post Surgery actions and recovery protocols PDF ACHILLES TENDON RUPTURE Accelerated Functional Rehabilitation Protocol Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. <> The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. Introduction. Plaster Cast or CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 1st week. %PDF-1.5 % Percutaneous and open surgical repairs of Achilles tendon ruptures: a comparative study. E=wNh|3Ln]8iwGuxfws7xl+|Y0~Pu The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. +2 b6b ] ]-oF%@ZUiV'US7\4yk@RAQA$EB-;D2yR"H#YH ~Z/K>S'E_ R>-C^^[i. Early functional rehabilitation protocol for Achilles tendon rupture improved patient satisfaction, compared with standard immobilisation regimens, with reductions in minor complications and no difference in re-rupture rates. This site needs JavaScript to work properly. endobj PDF ACHILLES RUPTURE: NONOPERATIVE PROTOCOL - South Bend Orthopaedic Associates One study allowed early mobilization leading to excellent subjective and objective results. Acute Ultrasonographic Investigation to Predict Rerupture and Outcomes in Patients with an Achilles Tendon Rupture. in surgical group, after injury in nonop. Results: Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. Acta Cir Bras. 2007 Nov 6;8:108. doi: 10.1186/1471-2474-8-108. The Thompson Test should be applied in all suspected cases Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury Non-Operative Treatment of Achilles Tendon Rupture Post-Operative Protocol Accelerated Rehabilitation Program: Weeks 1-2: Short leg fiberglass cast with ankle in plantarflexion of ~20 degrees Non-weight bearing with crutches for ambulation assistance Weeks 2-6: Transition to CAM walking boot with 6 heel lifts Achilles Tendon Rupture: Symptoms, Treatment, Recovery | HSS The best approach varies for each individual. An insight is given into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP to give an insight into the course of recovery after ATRs. eCollection 2023 Feb. Warneke K, Lohmann LH, Keiner M, Wagner CM, Schmidt T, Wirth K, Zech A, Schiemann S, Behm D. Int J Environ Res Public Health. FOIA PDF Achilles Tendon Rupture Conservative Management Accelerated Jogging, increase exercise intensity, Sports specific drills, Full active ankle range of movement with dorsiflexion as tolerated, Progress muscle strengthening from open chain to closed chain during this period, Single leg stance, eyes closed, wobble board/ BOSU, Double heel raise progress to single heel raise, Dorsiflexion equal to contralateral side, no need to push to extreme, Hopping, Mini hurdle jumps, Straight line running, Introduce cutting/side to side/ carioca/ figure of 8 runs, Normal activity, explosive actions and return to sport. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. He was able to ambulate without assistive devices at the 5-week follow-up examination. Achilles Tendon Rupture - Non-operative treatment rehabilitation ,dDu=hQ*S:m6 _0}NTD4%Dw $k7pQ(@Wi:s.K^ Percutaneous achilles tendon repair with absorbable suture: Outcomes Achilles Tendon Surgery: Preparation and Recovery - Verywell Health Hepatocyte Growth Factor-Induced Tendon Stem Cell Conditioned Medium Promotes Healing of Injured Achilles Tendon. Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon. Initially a walking boot is used for the first 4-5 weeks. Dynamic neuromuscular control with multi-plane activities, without pain or swelling. stream Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. 2 0 obj #WDA Arch Orthop Trauma Surg. 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