Active controlled motion in early rehabilitation improves outcome after ankle fractures: a randomized controlled trial

To evaluate the use of active controlled motion (ACM) after unstable ankle fractures needing initial partial weight-bearing.Prospective randomized controlled trial.Inpatient and outpatient clinic.A total of 50 patients with unstable ankle fractures and the need for partial weight-bearing for six weeks.Randomization in two groups: physiotherapy alone or physiotherapy with an additional ACM device.Follow-up after 6 and 12 weeks. Range of motion, visual analogue scale for foot and ankle (VAS FA), Philip score, Mazur score, American Orthopaedic FootAnkle Society (AOFAS) score and dynamic pedobarography.Range of motion was better in the ACM group at six weeks (mean 49° ± 11.1° vs. 41.3° ± 8.1°). Questionnaires revealed better outcome after six weeks in the VAS FA (56 ± 13.7 vs. 40.6 ± 10.5), Mazur score (64.4 ± 12.3 vs. 56.7 ± 11) and AOFAS score (71.2 ± 12 vs. 63.6 ± 8.7) ( P0.02 for all). Better outcome after 12 weeks in all questionnaires (VAS FA, 77.7 ± 13.8 vs. 61.4 ± 16.3; Philip score, 79.1 ± 10.9 vs. 60.1 ± 21.7; Mazur score, 83.9 ± 10.7 vs. 73.1 ± 14.1; AOFAS score, 87.5 ± 7.9 vs. 75.2 ± 11.7) ( P0.01 for all). Pressure balance was better under the midfoot region after 12 weeks in the ACM group (Δ P 4.4 N vs. 34.0 N; P = 0.01). The ACM group had an earlier return to work after 10.5 (range, 3-17) versus 14.7 (range, 9-26) weeks ( P = 0.02).The use of ACM for patients needing initial partial weight-bearing after operatively treated unstable ankle fractures in the first six postoperative weeks leads to better clinical and functional results and an earlier return to work.