Clinical and biomechanical recovery trajectories during anti-gravity treadmill-assisted rehabilitation after complex lower-limb articular fractures: a prospective pilot cohort study.

Abstract

PURPOSE: While previous research has established the clinical applicability of anti-gravity treadmill (AGT)-assisted rehabilitation after lower-limb fracture fixation, longitudinal biomechanical recovery in patients with complex AO/OTA C3 tibial plateau and pilon fractures remains poorly understood. MATERIALS AND METHODS: This prospective single-center cohort study included 17 adults (18-65 years) who underwent ORIF for AO/OTA C3 tibial plateau (n = 8) or pilon fractures (n = 9), followed by a structured AGT-assisted rehabilitation program. Independence in activities of daily living (ADLs), return to work and sport, radiographic outcomes, and gait analysis were assessed at 6 weeks, 3 months, and 6 months. RESULTS: Pain, ADLs, weight-bearing, and gait symmetry improved throughout follow-up. No mechanical complications, loss of reduction, or hardware failure were observed. ADL independence was achieved by 94% of patients at 6 weeks and by all at 3 months. Pilon fractures showed earlier restoration of loading symmetry, whereas tibial plateau fractures reached comparable values by 6 months. Gait analysis demonstrated progressive normalization of loading symmetry. CONCLUSION: This pilot study provides preliminary longitudinal clinical and laboratory-based biomechanical data on recovery after complex tibial plateau and pilon fractures managed within an AGT-assisted rehabilitation pathway. However, without a control group, the observed improvements cannot be attributed specifically to AGT.