achilles tendon rupture accelerated rehab protocol
basketball, tennis shots from standing start, contralateral -, Am J Sports Med. E=wNh|3Ln]8iwGuxfws7xl+|Y0~Pu Injury2014;45(11):1782-1790. PDF ACHILLES RUPTURE: OPERATIVE PROTOCOL - South Bend Orthopaedic Associates The acute rupture of the Achilles tendon is a protracted injury. No study found an increased rerupture rate for the more progressive treatment. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. xwn $8sxkL=. *MoaoLzhN:fOad)t-h96.&JxEys4JUy-nEu Goals: Protection of repair and achieve active dorsiflexion (DF) to neutral. The length of the incision and the surgical approach will depend on location of the rupture. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Stretching for patient-specific muscle imbalances. Rerupture after Achilles repair is reported at about 2-12%, with no statistical difference reported between open, percutaneous, augmented, or closed treatment methods [1-4, 7, 9, 16].Open rerupture is an exceedingly rare complication and has only been described a handful of times [17-19].This report is the first case that we are aware of described in the literature of an . official website and that any information you provide is encrypted 5 0 obj Achilles tendon repair is performed after injury occurs to the Achilles tendon. [1] [2] Achilles tendinopathy has a detrimental effect on physical and mental well-being [3] [4]. Epub 2017 Jan 17. 2022 Aug 19;2022:2363230. doi: 10.1155/2022/2363230. J Sci Med Sport. 2013 Dec;41(12):2867-76 The site is secure. ;ce%.WRu|^hR95eUmSkTusie\O~_TM6LoD,J/L-Y.Wjqw rU/>un+83ZI&|QUqsr7iWUJ/z\fv j7tvM bmmQ4Lz6kS2 K!bTFql:wGA?j)af/ \e9&Rx:V'mWJH~#u]2ZV=.7`yI10oRk 5sJ~bP[+;Ta;|r aQVJ~^%|8gd~YPnY@L}db'\2%k_ b7mQI00}yS$g7%i$wKfa58k&JV$ \&I[Z%sVl8= 1. doi: 10.1590/ACB360407. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. Begin by using one to two-inch heel lifts in tennis shoes for short distances on level surfaces and gradually remove heel lifts during the fifth through the eighth week depending on symptoms. The achilles tendon accounts for 20% of all large tendon injuries 1 with an estimated incidence ranging from 11 to 37 per 100,000. Scribd is the world's largest social reading and publishing site. Surgery is only the beginning of a long rehabilitation period. PDF Rehabilitation Guidelines for Achilles Tendon Repair - UW Health After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. <> ACHILLES RUPTURE: OPERATIVE PROTOCOL In this surgery, the torn ends of the tendon are sewn together with strong suture. Post-op weeks 3-4: boot at 10 degrees, sleep in boot, TTWB with crutches. Hydrotherapy 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 . All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Bookshelf <> It helps you walk, run, and jump. The Achilles tendon is a strong, fibrous cord in the lower leg. ':IU""e"E/JT?|OW:_Yn]n7buq}].moS_7xbU]}\o/|`ND^QTK/EnTYJ=U6~U1 Good control and no pain with sport/work-specific movements, including the impact. Keywords: After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Achilles Tendon Repair; ACL Reconstruction: Quadriceps Tendon Autograft; Graduated!resistanceexercises! %PDF-1.5 % 1995 Jan;98 (1):21-32 Achilles Tendon Rupture: Mechanisms of Injury, Principles of Low level calf plyometric exercises (fast CRs, tip toe Accelerated rehabilitation following Achilles tendon repair after acute hYmo6+DU f[j;;4vv+yw=lrD 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. Knee Surg Sports Traumatol Arthrosc. Walking). SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. 2 0 obj Arch Orthop Trauma Surg. Please enable it to take advantage of the complete set of features! York (UK): Centre for Reviews and Dissemination (UK); 1995-. OJSM 2016 2. Orthop J Sports Med. Operative versus non-operative treatment of acute Achilles tendon ruptures: a multi-center randomized trial using accelerated functional rehabilitation. With!weighted!resisted . PDF ACHILLES TENDON REPAIR CLINICAL PRACTICE GUIDELINE - Ohio State University It is found at the back of the lower leg, just above the heel bone. Introduction. The body then heals the tendon in the appropriate position. The .gov means its official. Accessibility Frontal and transverse plane agility drills (progress from low velocity to high, then gradually add in sagittal plane drills). L6YZN Ko:7}BFk| official website and that any information you provide is encrypted Accelerated Rehab Program | Mr Daniel Goldbloom | Melbourne of direction, jumping Accelerated rehabilitation; Achilles tendon rupture; Minimal invasive repair. Five trials compared full to non weight bearing, all applying immobilization in equinus. 228 0 obj <>stream PDF TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol Methods: Seven studies were included. Continue hip and Splint/Boot: Locked 20-30 degree plantarflexion for two weeks Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Do not perform exercises that create movement compensations. Normalize gait on all surfaces without boot or heel lift. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Fibrin biopolymer sealant and aquatic exercise association for calcaneal tendon repair. endstream endobj startxref Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. <> PDF ACCELERATED ACHILLES PROTOCOL - Indiana Total Therapy Percutaneous and open surgical repairs of Achilles tendon ruptures: a comparative study. Treatment of acute Achilles tendon rupture - a multicentre, non Ankle range of motion (ROM) respecting precautions. Return to the original sport at only 3 months after an Achilles tendon rupture by a combination of intra-tissue injection of freeze-dried platelet-derived factor concentrate and excessively early rehabilitation after operative treatment in a male basketball player: A case report. Introduction Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. This protocol was updated and reviewed by Dr. Devries and Dr. Scharer of BayCare Foot & Ankle Center and by Jessica Sigl, DPT on . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Accessibility Active ROM between 5 degrees of DF and 40 degrees of PF. <>/Metadata 358 0 R/ViewerPreferences 359 0 R>> Methods: Accelerated rehabilitation following Achilles tendon repair after acute Active stretching. Everything went well, had the staples removed yesterday. There is increasing evidence, summarized in systematic reviews, that one can successfully use a non-operative treatment protocol to manage patients who suffer an acute rupture of the Achilles tendon. Healing time clock restarts from day of surgery rather than day of injury Wr5)Z nK!e*~[~[)$WoU]sMHUoUbmJ9yOJ}` Several common injuries can make your Achilles tendon painful or prevent it from working well. Rehabilitation phases after an Achilles tendon rupture The rehabilitation can be divided into four phases (1): The decision when a patient should proceed from one phase to the next is proposed to be based on both the recovery of the patient and the time since the injury. Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. An Achilles tendon rupture surgery reconnects the ends of the torn tendon. eCollection 2021 Dec. Hidd SMCM, Tim CR, Dutra EF Jr, Maia Filho ALM, Assis L, Ferreira RS Jr, Barraviera B, Silva JF, Amaral MM. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. necessary. Disadvantages. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. 1.Introduction. 1 0 obj 2014 Nov;45(11):1782-90 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 ]. It happens most frequently while playing sports. Diagnosis can be made clinically with weakness of plantarflexion with a positive Thompson's test. Morimoto S, Iseki T, Nakayama H, Shimomura K, Nishikawa T, Nakamura N, Tachibana T. Regen Ther. 2021 Jun;24(6):536-543. doi: 10.1016/j.jsams.2020.12.005. 2020-2023 Mr Daniel Goldbloom | Privacy Policy | Disclaimer | Website design: Berwick - St John of God Consulting Suites. Regular soft tissue treatments (i.e. It attaches your two calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) and helps you go up onto tiptoes. ^C< ^/PgN`r3~LV*m{ (3Nl(+J?~I health, rehab compliance and injury severity, our team has established time frames, precautions and progression criteria that help ensure a safe return to sport. CAMBOOT with 10mm heel lift or VACOPED at (1) with flat sole for 4th week Partial Open chain strength exercises for quads, hamstrings, glutes hip flexors. PDF Achilles Tendon Repair: Post Operative Accelerated Rehabilitation Protocol Pain-free isometric ankle inversion, eversion, DF and submaximal PF. Active ankle eversion/inversion. of the Achilles tear and repair. Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. leg jumps, skipping). 3 0 obj In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment . The Achilles tendon, which is about 12-15 cm long and comprises both the gastrocnemius and the soleus tendons, is the thickest, strongest and largest tendon in the human body. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles 1,2 These reviews and other systematic reviews consistently show a slightly lower incidence of re-rupture with operative treatment, which is . Injury to the Achilles tendon causes pain along the back of your leg near the heel. J Bone Joint Surg Am. 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) Achilles Tendon rupture: Post Surgery actions and recovery protocols Accelerated rehabilitation following Achilles tendon repair after acute Download Accelerated Rehab Program Patient Information Sheet. Single leg stance with good control for 10 seconds. x=ko8?hsQH{i~Pb%1{$[lt@Y$ujzS^/W8X:RNj]_/U9..7z" Brumann M, Baumbach SF, Mutschler W, Polzer H. Injury. . Physical therapy appointments are once a week. 2016. : MOFL?Wo(H&dxl. 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 (open!andclosed!kinetic!chainas!well!as!functional activities)-!start!withTheraband!tubingexercises! Achilles Tendon Rupture : Wheeless' Textbook of Orthopaedics but an accelerated rehabilitation program should be accompanied by good results. Higher level proprioception nb^t~luNS zRBR}mHbKz!MKCZ?/ibO'"qwDG&lQz=>4 QG`7]qvZ;{t;-rq@ .iij1QB\:Lw;hxAMOPNw(v9`K-{ig@@HymirxF> Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-development of an evidence-based treatment protocol. Postoperative rehabilitation protocols for Achilles tendon ruptures: a Unauthorized use of these marks is strictly prohibited. Development of an accelerated functional rehabilitation protocol 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. 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. 2018 Mar;26(3):846-853. doi: 10.1007/s00167-015-3795-1. initially Disclaimer. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. FOIA Achilles Tendon Rupture - Core EM stream close menu Y!_x"o7/_"H4IE(:}/1 ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy Sport Medicine. Normal gait mechanics without the boot on all surfaces. 2014 2. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician. Achilles Tendon Rupture: What Is It, Symptoms & Treatment Cont. Initiate balance exercises (double leg wide base narrow . Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. Weight-bearing: Touchdown weight-bearing (TDWB) with crutches Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? Unable to load your collection due to an error, Unable to load your delegates due to an error. Front Cell Dev Biol. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. Cardiovascular: Upper body circuit training, Physical therapy appointments begin one to two visits per week. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. endobj Hydrotherapy may begin if wound healing is adequate. endobj A prospective randomized study. <> 3 0 obj BMC Musculoskelet Disord. It connects the muscles of your calf to your heel. Surgery is only the beginning of a long rehabilitation period. This combination was most beneficial. View a complete list of our locations and hours. National Library of Medicine <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 5 0 R/Group<>/Tabs/S/StructParents 1>> government site. Knee Surg Sports Traumatol Arthrosc. As a result, an effective rehabilitation protocol for Achilles tendon rupture appears to be more important than the surgical treatment method itself. Unable to load your collection due to an error, Unable to load your delegates due to an error. A Closer Look At A New Protocol To Manage Achilles Tendon Rupture Clipboard, Search History, and several other advanced features are temporarily unavailable. plantar grade only. Moderate load close/open chain calf strengthening to Slowly wean from boot. Close suggestions Search Search. Functional Rehabilitation for Nonsurgical Treatment of Acute Achilles Cardiovascular: stationary bike, StairMaster, swimming. 2016 Jun;24(6):1852-9. doi: 10.1007/s00167-014-3180-5. 24 staples. Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. without in air contact Various treatment methods are used for acute and chronic rupture. The acute rupture of the Achilles tendon is a protracted injury. PDF Standard of Care: Achilles Tendinopathy - Brigham and Women's Hospital Closed chain weight bearing quads, hamstrings, glutes, calf strengthening with physio guidance. PDF Rehabilitation Protocol for Achilles Rupture Repair 8]z].U3wKI2 We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with tendon augmentation, re-rupture after non-surgical management, revision, chronic tendinosis, and co-morbidities, for example, obesity, older age, and steroid use. In some cases, the Achilles tendon can tear, or rupture. 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. PDF Rehabilitation Guidelines: Post Achilles Tendon Reconstruction 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. 4d1olrz?+Vg.TxH38@ g%L !.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 Wilkins R, Bisson Lj. Achilles Tendon Rupture - Foot & Ankle - Orthobullets "A new treatment of ruptured Achilles tendons. q{b7\68wbZaX?MN3 ,iFaI!_>bT=BL~>k9Z'V>Y'Zo5M:Bt>Oby^|pRh/0UhclP"t~** 0! Design Scoping review. Squat and lunge to 70 degrees knee flexion without weight shift. Bookshelf A prospective randomized study." Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Ankle strengthening concentric and eccentric gastroc strengthening. 1 0 obj Physio guided passive range of motion no more than neutral. The acute rupture of the Achilles tendon is a protracted injury. Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Knee Surg Sports Traumatol Arthrosc. Passive dorsiflexion both with knee in extension and flexed to 35 - 400 until gentle stretch on achilles. . 4 0 obj The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. . % PDF Non-Operative Treatment of Achilles Tendon Ruptures Phase 1 Maximum Epub 2020 Dec 17. (10% body Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Dynamic neuromuscular control with multi-plane activities, without pain or swelling. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). 0 <>/Metadata 1559 0 R/ViewerPreferences 1560 0 R>> Before In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment. stream [PubMed: 25059505]. Functional movements (squats, step backs, lunges). 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. In an acute Achilles Tendon Rupture, there are two options: Surgical repair with accelerated rehab protocol. Goals: PT appointments are once every one to two weeks. Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Independent gait. 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). Epub 2015 Sep 26. The tendons twist from proximal to distal as they insert into the calcaneous, creating a shearing force. Can commence light isometric calf exercises at low resistance and reps, not past plantar grade. Continue active resisted theraband exercises; plantarflex through full range, dorsiflexion to a natural plantigrade position, push no further. Our rehab protocols outline timing, precautions and progression criteria for returning to activity. Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials. Conclusion: Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. Results: Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. <> endobj 2003 Jun;54(6):1171-80; discussion 1180-1. doi: 10.1097/01.TA.0000047945.20863.A2. eCollection 2021. Lightsey HM, Noback PC, Caldwell JE, Trofa DP, Greisberg JK, Vosseller JT. 2,3 Controversy still surrounds what the optimal treatment for achilles tendon ruptures is. -, Injury. Five trials compared full to non weight bearing, all applying immobilization in equinus. `p19~%t?JGw]Sv+[ ]RDir)A) '$M*0 eC5 7<81$^;c! Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. The Alfredson Protocol is an exercise program for people with Achilles tendonitis ( tendinopathy ). Torn Achilles Rehabilitation - Following Surgery and Non Surgical TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol Time Frame Activity 0-2 weeks Posterior slab/splint; non-weight-bearing with crutches: immed. Accelerated rehabilitation following Achilles tendon repair after acute endobj A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. The Alfredson Protocol for Achilles Tendonitis - Verywell Health government site. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. One study allowed early mobilization leading to excellent subjective and objective results. Metz R, Kerkhoffs GM, Verleisdonk EJ, van der Heijden GJ. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. 3 What to Wear You can wear anything comfortable for your surgery appointment. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. weight We performed a systematic literature search in Medline, Embase and Cochrane library. The https:// ensures that you are connecting to the endobj -, Am J Sports Med. Achilles Tendon Injuries | Johns Hopkins Medicine Centre for Reviews and Dissemination (UK), York (UK). =+Q%90Z6U='-rj\Ig pV.4FqW%W)53s^#D3 a`CN3=z[lmOgEA5CWwpLz9r4-+94Is9>}n-9k=n6R LAJxeF$ylM>MY@0vFEviCM ml@5s? <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> MeSH Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. Treatments are chosen based on the size of the tendon defect. Patient 2 was a 38-year-old male soldier who experienced a complete left Achilles tendon rupture while exercising. Very gently at first and gradually build up . Lantto et al. 1 0 obj 2007 Nov 6;8:108. doi: 10.1186/1471-2474-8-108. 3 0 obj Avoid overstressing the repair (avoid large movements up and down, forceful PF while in a dorsiflexed position, aggressive passive ROM, and impact activities). PDF ACHILLES TENDON RUPTURE Accelerated Functional Rehabilitation Protocol Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol. Emerg Med Int. MeSH ?ynKdl?~\X%__ =x18?O/Wo_I7j~tIdM)E:_QF'ljY*u=9PEF^},? Sports massage techniques and ultrasound can aid torn Achilles rehabilitation by helping to realign the new fibres in line with the tendon. bearing transitioning towards full weightbearing. CAMBOOT with 20mm heel lift or VACOPED (2) and wedge sole for 3rd week. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Initially a walking boot is used for the first 4-5 weeks. 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. 24 staples. 4 0 obj 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. eCollection 2022. Effect of Transdermal Fentanyl Patch Combined with Enhanced Recovery after Surgery on the Curative Effect and Analgesic Effect of Liver Cancer.