There are three things that need to be kept in mind while rehabilitating a ruptured Achilles: range of motion, functional strength, and sometimes orthotic support. Range of motion is important because it takes into mind the tightness of the repaired tendon. When beginning rehab a patient should perform stretches lightly and increase the intensity as time and pain permits. Putting linear stress on the tendon is important because it stimulates connective tissue repair, which can be achieved while performing the “runners stretch,” (putting your toes a couple inches up the wall while your heel is on the ground). Doing stretches to gain functional strength are also important because it improves healing in the tendon, which will in turn lead to a quicker return to activities. These stretches should be more intense and should involve some sort of weight bearing, which helps reorient and strengthen the collagen fibers in the injured ankle. A popular stretch used for this phase of rehabilitation is the toe raise on an elevated surface. The patient is to push up onto the toes and lower his or her self as far down as possible and repeat several times. The other part of the rehab process is orthotic support. This doesn’t have anything to do with stretching or strengthening the tendon, rather it is in place to keep the patient comfortable. These are custom made inserts that fit into the patients shoe and help with proper pronation of the foot, which is otherwise a problem that can lead to problems with the Achilles. [ citation needed ]
Rheumatoid arthritis, Parkinson's disease, chronic steroid therapy, osteopenia, and female gender have all been found to be risk factors for postoperative periprosthetic supracondylar femur fractures. Male gender has not been found to be a risk factor.
Su et al discuss risk factors for supracondylar periprosthetic femoral fractures which include rheumatoid arthritis, neurologic disorders such as Parkinson's disease, chronic steroid therapy, and revision knee arthroplasty. Analysis of the Mayo Clinic joint registry by Berry found that females are at increased risk of postoperative periprosthetic fracture, likely due to the increased incidence of osteoporosis. There is controversy regarding anterior cortical notching (Illustration A) and increased risk for periprosthetic fracture.
Lesh et al performed a biomechanical study on the consequences of anterior femoral notching. Using cadaveric matched femora with and without full thickness anterior cortex defects above TKA implants, they found that notching decreased both bending and torsional strength in the supracondylar region of the femur. They also found that fracture orientation differed between the two groups following the application of a bending load.
Ritter et al in a series of 670 total knee arthroplasties, of which 27% had notching (