Alterations in structure of the muscle-tendon unit and gait pattern after percutaneous repair of Achilles tendon rupture with the Dresden instrument

Manegold, Sebastian; Tsitsilonis, Serafeim; Gehlen, Tobias; Kopf, Sebastian; Duda, Georg N.; Agres, Alison N.

doi:10.1016/j.fas.2018.04.004

Cited by 19 publications

(44 citation statements)

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“…23,27,35,40,43 Since ruptured tendons elongate during healing and rehabilitation, and lengthening leads to poor function, 14,18,22,47 they would benefit from being repaired in increased plantarflexion. Repairing in greater tightness to the contralateral side is commonly performed 15,19,21,26,29,42,45 ; however, to the best of our knowledge, this is the first study providing data to support the influence of tightness of repair on functional (heel-rise) performance. Excessive elongation of the Achilles tendon after rupture is common.…”

Section: Discussionmentioning

confidence: 92%

“…11 Additionally, the dynamic form of this assessment, originally described by Matles, 31 has recently been used to examine for lengthening after surgical repair. 29 The HRHI was selected as the primary variable of interest because of its relationship to long-term outcomes after an Achilles tendon rupture. 4 HRHI is defined as heel-rise height (injured)/heel-rise height (noninjured) and is expressed as percentage.…”

Section: Discussionmentioning

confidence: 99%

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Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Carmont

Zellers

Brorsson

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose: To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair. Study Design: Cohort study; Level of evidence, 3. Methods: From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI. Results: A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m2). The elapsed time to surgery was 6.5 ± 4.0 days. At 12-month follow-up, patients had an HRHI of 82% ± 16% and performed 82% ± 17% of repetitions compared with the noninjured side. Participants had a mean ATRS of 87 ± 15 and a median Tegner score of 5 (range, 1-9), with a reduction in Tegner score of 2 from preinjury levels. The relative ATRA at 12 months was –4.8° ± 3.9°. Multiple regression identified younger age (B = ±0.006; P < .001) and greater intraoperative ATRA (B = 0.005; P = .053) as predictors of more symmetrical 12-month HRHI ( R 2 = 0.19; P < .001; n = 120). Conclusion: Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Carmont

Zellers

Brorsson

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Apart from functional deficits, Achilles tendon rupture results in alterations of the neuromechanical properties of the muscle-tendon unit including tendon elongation, triceps surae atrophy and compensatory changes in muscle activation [12,13,16]. Manegold and coworkers [17] showed that Achilles tendon elongation and tricep surae atrophy are related to the deficits in strength and ROM that are often seen in the ankle joint. This remains one of few studies that has sought to understand the mechanisms underpinning deficits in functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

Morphological and functional outcomes of operatively treated Achilles tendon ruptures

Nicholson

Walker

Dawson

et al. 2019

The Physician and Sportsmedicine

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Objectives: Achilles tendon rupture leads to functional impairments and these may be underpinned by morphological changes in the muscle-tendon unit. Functional performance of the injured limb will be impaired regardless of time since surgery and these impairments occur alongside changes in muscle-tendon morphology. Methods: Following operative treatment of Achilles tendon rupture and short term immobilisation, 12 patients completed a battery of tests during a single visit to the laboratory (performed an average of 4.4 ± 2.6 years post-surgery). Patients completed the Achilles' tendon rupture score (ATRS), tests of ankle and hip range of motion (ROM) and ultrasound measurements of muscle-tendon architecture. Data on isokinetic (30 o /s, 60 o /s) plantar flexion strength, jumping performance and walking-running were also collected on the same visit. Percentage deficits were expressed relative to the non-injured limb and determined for statistical significance (p < 0.05). Relationships between outcomes measures and time since surgery were tested using Pearson's correlation coefficients (p < 0.05). Results: The repaired limb showed a shorter muscle fascicle length (12.1-19.6%), increased fascicle pennation (18.0±22.14%) and reduced muscle thickness (9.1-20.1%) in the gastrocnemius and/or soleus along with greater tendon cross-sectional area (46.7±34.47%). Functionally, the repaired limb displayed lower countermovement jump height (-12.6±15.68%) and longer drop jump contact times (5.5±5.7%). Also, the repaired limb showed reduced hip internal-external ROM (6.3±8.2%) but no differences existed between limbs for plantar flexion ROM and strength or gait characteristics. Good ATRS outcomes were reported (mean: 87.9±16.2, range: 43-100) which related to time since surgery (r=0.79) but individual ATRS items did not correlate with corresponding objective measures. Conclusion: Plantar flexor atrophy following surgically treated Achilles tendon rupture is partially compensated for by remodelling of the fascicles however, impairments may still persist many years into the postoperative period although these may be more pronounced in high-velocity activities.

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“…Rupture of Achilles tendon is a common injury observed in recreational and professional athletes [1][2][3] . Partial or total rupture of the Achilles tendon demands special attention since prolonged periods of tissue impairment can induce permanent alterations in the normal gait pattern of patients 4 . The treatment of ruptured Achilles tendon is generally made by surgical intervention being time of recovery variable among individuals 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Total rupture of achilles tendon induces inflammatory response and glial activation on the mice spinal cord 

Paula

França

Leão

et al. 2020

Preprint

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Rupture of Achilles tendon is a common accident affecting professional and recreational athletes. Acute and chronic pains are symptoms commonly observed in ruptured patients. Despite that, no studies have described whether Achilles tendon rupture is able to promote disorders in CNS. Based in these finds, the current study aimed to evaluate nociceptive alterations and inflammatory response in L5 lumbar segment of Balb/c mice spinal cord after Achilles tendon rupture. We demonstrated increased algesic response in the paw of ruptured group on the 7th and 14th days post tenotomy when compared with control group. This phenomenon was accompanied by over expression of COX-2 and NOS-2 as well as hyperactivation of astrocytes and microglia in nociceptive areas of L5 spinal cord as evidenced by intense GFAP and IBA-1 immunostaining, respectively. Biochemical studies also demonstrated increased levels of nitrite in the L5 spinal cord of tenotomized animals when compared with control group. Thus, we have demonstrate for the first time that total rupture of the Achilles tendon induces inflammatory response, nitrergic and glial activation in the CNS at L5 spinal cord region.

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Alterations in structure of the muscle-tendon unit and gait pattern after percutaneous repair of Achilles tendon rupture with the Dresden instrument

Cited by 19 publications

References 45 publications

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Morphological and functional outcomes of operatively treated Achilles tendon ruptures

Total rupture of achilles tendon induces inflammatory response and glial activation on the mice spinal cord

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Alterations in structure of the muscle-tendon unit and gait pattern after percutaneous repair of Achilles tendon rupture with the Dresden instrument

Cited by 19 publications

References 45 publications

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Morphological and functional outcomes of operatively treated Achilles tendon ruptures

Total rupture of achilles tendon induces inflammatory response and glial activation on the mice spinal cord&nbsp;

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Total rupture of achilles tendon induces inflammatory response and glial activation on the mice spinal cord