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

摘要 跟腱断裂在过去30年里增加了10倍，但康复负荷方案 仍然是笼统的，结果不可预测，而且总体上很差。当临床共识存在的时候 支持早期肌腱加载以促进愈合，最大限度地提高加载幅度和频率 功能结果尚不清楚。这项高风险、高回报的研究将利用现有的小规模 系统确定精确康复负荷是否减轻有害肌肉的动物模型- 肌腱结构发生变化，从而保留了踝关节功能。为了测试每日主动肌肉负荷的效果， 神经刺激袖带将通过手术植入胫神经。通过刺激胫神经，精确地 肌腱负荷将每天提供，以促进肌腱愈合和防止肌肉重塑。在AIM 1.动物将接受模拟肌腱断裂、手术肌腱修复和制动，然后进行笼子 活动。在整个制动过程中，动物将接受每天的肌肉兴奋曲线来刺激活性 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 活跃的肌肉收缩不会进一步损害正在愈合的肌腱。这个时间线有直接的 翻译为跟腱断裂后给患者开出的康复时间表。在目标2中， 性别作为生物变量的影响将通过将相同数量的雄性和雌性大鼠包括在 各试验组。这项研究的主要结果是主动的足底屈肌扭矩产生在 整个脚踝运动范围。通过计算脚踝所做的总功，这些实验将提供 这是迄今为止支持精确修复的最严格的证据。这项研究的次要结果 是肌腱延长和肌肉重塑，这是患者和计算机实验证实的 支配脚踝功能的机械机制。这项研究将是第一次确定精确度 保留肌腱结构和恢复踝关节功能的康复负荷曲线 跟腱断裂及修复。重要的是，患者可以在以下情况下生成指定的脚踝负荷曲线 在小腿强化活动中提供视觉反馈。这种直接转变为临床护理的方式将发生转变 康复范式从泛化加载转向精准加载。

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.