Design of Physical Intervention Protocol after Achilles Tendon Repair: in the View of Microcirculation
Date Issued
2015
Date
2015
Author(s)
Chang, Yi-Ping
Abstract
Background: Tendon microcirculation is considered to be associated with the tendon healing. Few prospective studies investigated neither changes of the tendon microcirculation nor its predicting role after the tendon repair. On the other hand, physical agents are considered to be beneficial for the tissue repair, however, only a few research investigated the effects of the physical agents from the viewpoint of microcirculation. Purpose: The study was aimed to investigate the roles of intratendinous microcirculation in the early phase (1, 2 and 3 months postsurgery) of the tendon repair to clinical severity/ outcome measures afterwards, and to investigate the microcirculatory effects by commonly-used physical agents in clinically setting on the healthy tendon. Design: The study consists of two parts. The first part is a case cohort study, and the second part is a cross-sectional study. Participants: The first part of the study recruited patients who received a unilateral Achilles tendon repair; the second study recruited asymptomatic healthy adults. All the subjects aged between 20~65 years old. Methods: In the first part, the subjects underwent measurements of the tendon microcirculation after 1, 2 and 3 months postsurgery, and assessments of the clinical severity, tendon mechanical property and functional performances (heel raise test index, star excursion balance test and one-leg hopping) after 3 and 6 months postsurgery; in the second part, the subjects were randomly allocated to four groups undergoing one of the intervention of therapeutic ultrasound, low-level laser therapy, interferential current or vibration gun separately. The examinations of tendon microcirculation were performed before and after the intervention. Statistical analysis: Wilcoxon signed-rank test and Spearman''s rank correlation analysis were used for the purposes of the study. Results: In the first part of the study, the results showed that the total hemoglobin of the repaired tendon was significantly greater than the one at the healthy side after 1, 2 and 3 months postsurgery (p<0.05); the oxygen saturation of the repaired side was significantly greater than the one at healthy side after 3 month postsurgery (p=0.017). Besides, the changes of the calibrated value (operated side minus healthy side) of the total hemoglobin in the early phase postsurgery showed negative correlations with the clinical severity (r=-0.821, -0.929) and heel raise test index (r=-0.833), and positive correlations with the balance function and differences in normalized one-leg hopping distance (healthy side minus operated side) (r=0.786, 0.893/ 0.929, 0.786) in the late phase. In the second part, the results showed that the tendon microcirculation significantly increased after the intervention of the therapeutic ultrasound with the 0.8 and 1.2 W/cm2 of the intensity as well as the mechanical vibration targeting on the tendon (p=0.002~0.006). Conclusion: The microcirculatory changes of Achilles tendon in the first three months postsurgey were correlated with the clinical severity and functional performances after 3 months postsurgery. It could be speculated to have promoting effects on the improvements of clinical severity and functional performances if improving the tendon microcirculation in the early phase postsurgery. The findings of the microcirculatory effects by the therapeutic ultrasound and mechanical vibration on the tendon built a foundation for the subsequent investigations of the further application to the injured tendon or long-term intervention studies.
Subjects
Achilles tendon
microcirculation
clinical severity
functional performances
physical agents
Type
thesis
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