Knee Joint Kinematics and Kinetics During Walking and Running After Surgical Achilles Tendon Repair

Abstract

Background:Despite the increasing incidence of Achilles tendon (AT) ruptures, there is a lack of information on the possible risks associated with regular running and walking for exercise after an injury. There are some known kinematic gait changes after an AT rupture, especially at the knee. However, it is not clear whether runners with AT ruptures may be at risk for secondary knee injuries during shod or barefoot running/walking.Purpose/Hypothesis:The purpose of this study was to compare the kinematics and kinetics of barefoot walking and barefoot and shod running between athletes with a history of AT ruptures and a healthy control group. We hypothesized that there would be increased knee joint loads in the affected limb of the AT rupture group, especially during shod running.Study Design:Controlled laboratory study.Methods:Ten patients who had undergone surgical treatment of a unilateral acute AT rupture (6.1 ± 3.7 years postoperatively ) and 10 control participants were matched according to age, sex, physical activity, weight, height, and footfall type. The kinematics and kinetics of barefoot walking and barefoot and shod running were recorded using a high-speed motion capture system synchronized with force platforms.Results:The main outcome measures were lower extremity joint angles and moments during the stance phase of walking and running. After AT repair, athletes had increased internal knee abduction moments during shod and barefoot running compared with the healthy control group (P < .05, η2 > 0.14). There were no significant differences in kinematics and kinetics during walking between the AT rupture and healthy control groups (P ≥ .05).Conclusion:After an AT rupture, athletes had increased internal knee abduction moments during running compared with the healthy control group.Clinical Relevance:The increased abduction loads on the knee in patients with an AT rupture could lead to further running-related injuries. However, barefoot walking may be used as a proprioceptive exercise without an increased risk of overuse injuries in these patients.

A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon

“…The increased knee joint loading may be attributed to weakened ankle plantar flexor function and elongation of the AT during higher demand tasks like jogging, running and even basic locomotion like walking. The findings of this study were inconsistent with earlier works that showed significantly greater patellofemoral joint loading in the injured leg only during high-demand activities but not during walking in patients after surgical ATR repair [41,43]. The reason for the inconsistency may be due to the different physical activity levels and follow-up time of the subjects.…”

“…Thus the shorter triceps surae fascicles in the involved limb may promote a deficit in plantar flexor power generation [42]. The compromised plantar flexor function of the injured leg following an ATR may compensate by increased work done by the ipsilateral knee joint [43]. In this study, increased knee extension angles and elevated knee joint moments were found in the involved limb during all activities.…”

“…The deficit of plantar flexor muscle operation in the sagittal plane may be substituted by increased loading in the frontal plane of the lower limb joints [50]. Consistently, Jandacka et al reported that a weakened and elongated AT may be the main reason causing altered sagittal plane knee and ankle joint kinematics and increasing lower extremity frontal-plane loading as a consequence [43].…”

Morphological and functional outcomes of operatively treated Achilles tendon ruptures

“…The reduced hip external and internal rotation ROM of the injured limb was a novel finding of the present investigation. That being said, previous investigations into running mechanics following Achilles tendon ruptures have observed increased knee joint loads [44] and internal knee abduction moments [45] in the injured limb. It is not possible to identify if impairments in the ROM in the current study are the result of post-operation movement management or they existed prior to the Achilles tendon rupture.…”

Coordination variability in runners after surgical Achilles tendon repair

“…Maximum knee flexion and the maximum knee internal abduction moment occurred at the time interval of maximum subtalar eversion while the tibia synchronously undergoes internal rotation. 2,35,36 In our study, the AT group exhibited greater in-phase and distal-phase movement of the foot and shank, while the control group rotated more at the shank (proximal rotation) (Needham et al, 2015). This coordination pattern occurred between 47.2% and 50.3% of stance during which time the AT group had increased coordination variability (Figure 1).…”