Cerutti Giacomo
In recent years, unfortunately, its rupture is increasingly frequent in both professional and amateur
athletes.
For professional athletes, one of the major causes of injuries is certainly the increase in functional
demands given by the numerous competitive events.
As far as amateurs are concerned, lack of preparation is among the primary causes.
Here, we report the case of a 41 years old female, runner and amateur volley ball player.
Our patient weighs 60 kilograms: this data will be useful in the future.
The lesion mechanism occurred following a wall attack during a volleyball match, with immediate
functional disability.
From the beginning his goal was first to go back to running, then to play volleyball and beach
volleyball.
Until today, there are limited available evidence and guidelines for the rehabilitation.
The Gait study group (German, American, Italian tendon) wondered what were the most important
issues on which to clarify regarding the rehabilitation following the reconstruction of the Achilles
tendon 1.
A value of 100% agreement by all the members was set to produce a proposed consensus statement.
A value of 80% consensus was set to produce “strong recommendation 1.”
Following this, a systematic review was performed.
Our athlete’s return to sport was carried out step by step according to what was reported by the Gait
study group, using technological device-tools to control load-modulation and to measure clinical
and functional progress.
In recent years several studies have been carried out which have been characterized by diversity of
thought regarding the post operative management.
Early mobilization, weightbearing, outcome measures have been the most discussed topics to make
the return to sport as safe as possible.
A specific and evidence based shared rehabilitation protocol is still lacking.
This study had the aim of using criteria of progression in specific exercises, thanks to outcome
measures, in different phase of rehabilitation.
Getting performance data, we had the opportunity to understand when to start the specific sport
rehabilitation phase, to reduce the risk of associated complications and guarantee the athlete a safe
return to sport.
The last battery of tests before the gradual return to sport is made up of:
• Isokinetic Balance Concentric Test (Leg press)
• T-Test
• Drift Test
• Hop Forward – Long for distance
The patient returned to running and amateur competitive activity (volleyball) after 9 months,
making a gradual return to sport.
She is currently continuing, following our guidance, to continue with strength and conditioning
locally and globally.
In maintenance to be performed independently, exercises that focus on energy storage and release
and jumps, a fundamental skill in sports such as volleyball and beach volleyball, have not been
overlooked.
We remained available for any clarifications and agreed on how to proceed for the subsequent
return to sport for volleyball, as far as timing is concerned.
It will be necessary to carry out a follow-up to observe if our patient is also affected by the deficits
mentioned above around 3.5 years.
This treatment proposal is only a beginning and a cue for future studies involving a greater number
of people to have greater certainty on rehabilitation after Achilles tendon repair.
The limited number of people involved and the lack of randomization in the studies cited in this
case report are the two main reasons for saying that further research is needed.
-Saxena A, Giai Via A, Grävare Silbernagel K, et al. Current Consensus for Rehabilitation
Protocols of the Surgically Repaired Acute Mid-Substance Achilles Rupture: A Systematic
Review and Recommendations From the “GAIT” Study Group. J Foot Ankle Surg.
2022;61(4):855-861. doi:10.1053/j.jfas.2021.12.008
-Wenning M, Mauch M, Heitner A, Lienhard J, Ritzmann R, Paul J. Neuromechanical
activation of triceps surae muscle remains altered at 3.5 years following open surgical repair
of acute Achilles tendon rupture. Knee Surgery, Sport Traumatol Arthrosc. 2021;29(8):2517
2527. doi:10.1007/s00167-021-06512-z
-Wenning M, Mauch M, Heitner A, Streicher P, Ritzmann R, Paul J. Midterm functional
performance following open surgical repair of acute Achilles tendon rupture. Arch Orthop
Trauma Surg. 2022;142(7):1337-1349. doi:10.1007/s00402-020-03746-3
-Heikkinen J, Lantto I, Piilonen J, et al. Tendon length, calf muscle atrophy, and strength
deficit after acute achilles tendon rupture: Long-term follow-up of patients in a previous
study. J Bone Jt Surg – Am Vol. 2017;99(18):1509-1515. doi:10.2106/JBJS.16.01491
-Docking SI, Cook J. How do tendons adapt? Going beyond tissue responses to understand
positive adaptation and pathology development: A narrative review. J Musculoskelet
Neuronal Interact. 2019;19(3):300-310.
-Maffulli N, Gougoulias N, Maffulli GD, Oliva F, Migliorini F. Slowed-Down Rehabilitation
Following Percutaneous Repair of Achilles Tendon Rupture. Foot Ankle Int. 2022;43(2):244
252. doi:10.1177/10711007211038594
-Baxter JR, Corrigan P, Hullfish TJ, O’Rourke P, Silbernagel KG. Exercise Progression to
Incrementally Load the Achilles Tendon. Med Sci Sports Exerc. 2021;53(1):124-130.
doi:10.1249/MSS.0000000000002459
-Maffulli N, Longo UG, Testa V, Oliva F, Capasso G, Denaro V. Italian translation of the
VISA-A score for tendinopathy of the main body of the Achilles tendon. Disabil Rehabil.
2008;30(20-22):1635-1639. doi:10.1080/09638280701785965
-McCormack J, Underwood F, Slaven E, Cappaert T. the Minimum Clinically Important
Difference on the Visa-a and Lefs for Patients With Insertional Achilles Tendinopathy. Int J
Sports Phys Ther. 2015;10(5):639-644.
http://www.ncbi.nlm.nih.gov/pubmed/26491614%0Ahttp://www.pubmedcentral.nih.gov/arti
clerender.fcgi?artid=PMC4595917
-Blaise D, Berg Frederic. La Salute Nella Corsa. (Mulatero, ed.).; 2020.
