Precision rehabilitation to restore plantar flexor function following Achilles tendon rupture repair

总结 在过去的30年里，跟腱断裂增加了10倍，但康复负荷方案 仍然是普遍的，具有不可预测的和通常较差的结果。虽然临床共识存在 支持早期肌腱负荷以促进愈合，最大化的负荷幅度和频率 功能结果仍然未知。这项高风险高回报的研究将利用一个既定的小 动物模型，以系统地确定精确的康复负荷是否减轻有害的肌肉- 肌腱结构改变，从而保留踝关节功能。为了测试日常活动肌肉负荷的效果， 神经刺激袖带将通过手术植入胫神经。通过刺激胫神经， 肌肉-肌腱负荷将每天传递以促进肌腱愈合并防止肌肉重塑。在aim中 1，动物将经历模拟肌腱断裂，手术肌腱修复，并固定后笼 活动在整个固定过程中，动物将接受每日肌肉兴奋曲线，以刺激活动 肌肉收缩这些肌肉收缩将在肌腱应变阈值以下进行，以确保 主动的肌肉收缩不会进一步损伤正在愈合的肌腱。这条时间轴 转换为跟腱断裂后规定患者的恢复时间轴。在目标2中， 将通过纳入相同数量的雄性和雌性大鼠来测试性别作为生物学变量的影响， 每个实验组。本研究的主要结果是主动跖屈肌扭矩产生超过 整个踝关节活动范围。通过计算踝关节所做的总功，这些实验将提供 这是迄今为止支持精确复原的最有力证据。本研究的次要结局 是肌腱延长和肌肉重塑，患者和计算实验证实， 控制踝关节功能的机械机制。这项研究将是第一个确定精度 康复负荷配置文件，保留肌肉肌腱结构和恢复踝关节功能， 跟腱断裂与修复。重要的是，患者可以生成规定的踝关节负荷曲线， 在小腿加强活动期间提供视觉反馈。这种直接转化为临床护理的方式将改变 康复范式从广义负荷转向精确负荷。

SUMMARY Achilles tendon ruptures have increased 10-fold in the last 3 decades but rehabilitation loading protocols remain generalized with unpredictable and generally poor outcomes. While clinical consensus exists supporting early tendon loading to promote healing, the loading magnitudes and frequencies that maximize functional outcomes remain unknown. This high-risk high-reward study will leverage an established small animal model to systematically determine whether precision rehabilitation loading mitigates deleterious muscle- tendon structural changes, thus preserving ankle function. To test the effects of daily active muscle loading, nerve stimulating cuffs will be surgically implanted on the tibial nerve. By stimulating the tibial nerve, precise muscle-tendon loads will be delivered daily to promote tendon healing and prevent muscle remodeling. In aim 1, animals will undergo simulated tendon rupture, surgical tendon repair, and immobilization followed by cage activity. Throughout immobilization, animals will receive daily muscle excitation profiles to stimulate active muscle contractions. These muscle contractions will be delivered below the tendon strain threshold to ensure that the active muscle contractions do not further damage the healing tendon. This timeline has direct translation to the recovery timeline that patients are prescribed following an Achilles tendon rupture. In aim 2, the effects of sex as a biologic variable will be tested by including equal numbers of male and female rats in each experimental group. The primary outcome of this study is active plantar flexor torque generate over the entire range of ankle motion. By calculating the total work done by the ankle, these experiments will provide the most rigorous evidence to date in support of precision rehabilitation. The secondary outcomes of this study are tendon elongation and muscle remodeling, which patient and computational experiments confirm are the mechanical mechanisms that govern ankle function. This study will be the first to identify precision rehabilitation loading profiles that preserve muscle-tendon structure and restore ankle function following Achilles tendon rupture and repair. Importantly, patients can generate prescribed ankle loading profiles when provided with visual feedback during calf strengthening activities. This direct translation to clinical care will shift the rehabilitation paradigm away from generalized loading to precision loading.