Long-term biomechanical outcomes after Achilles tendon ruptures

Rosso, Claudio; Buckland, Daniel M.; Polzer, Caroline; Sadoghi, Patrick; Schuh, Reinhard; Weisskopf, Lukas; Vavken, Patrick; Valderrábano, Víctor

doi:10.1007/s00167-013-2726-2

Cited by 44 publications

(50 citation statements)

References 40 publications

(84 reference statements)

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“…Though the type of treatment was limited to only one type of surgery, it is likely that these results are indicative of other surgical and conservative treatments. Previous work has shown that long-term biomechanical outcomes after ATR appear to be similar when comparing nonoperative treatments, open, and percutaneous surgeries (Rosso et al, 2013). Within this study intra-patient ratios of AT length were compared Fig.…”

Section: Discussionmentioning

confidence: 98%

Increased unilateral tendon stiffness and its effect on gait 2–6 years after Achilles tendon rupture

Agres

Duda

Gehlen

et al. 2015

Scandinavian Med Sci Sports

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Achilles tendon rupture (ATR) alters tissue composition, which may affect long-term tendon mechanics and ankle function during movement. However, a relationship between Achilles tendon (AT) properties and ankle joint function during gait remains unclear. The primary hypotheses were that (a) post-ATR tendon stiffness and length differ from the noninjured contralateral side and that (b) intra-patient asymmetries in AT properties correlate to ankle function asymmetries during gait, determined by ankle angles and moments. Ultrasonography and dynamometry were used to assess AT tendon stiffness, strain, elongation, and rest length in both limbs of 20 ATR patients 2-6 years after repair. Three-dimensional ankle angles and moments were determined using gait analysis. Injured tendons exhibited increased stiffness, rest length, and altered kinematics, with higher dorsiflexion and eversion, and lower plantarflexion and inversion. Intra-patient tendon stiffness and tendon length ratios were negatively correlated to intra-patient ratios of the maximum plantarflexion moment and maximum dorsiflexion angle, respectively. These results suggest that after surgical ATR repair, higher AT stiffness, but not a longer AT, may contribute to deficits in plantarflexion moment generation. These data further support the claim that post-ATR tendon regeneration results in the production of a tissue that is functionally different than noninjured tendon.

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Section: Discussionmentioning

confidence: 98%

Increased unilateral tendon stiffness and its effect on gait 2–6 years after Achilles tendon rupture

Agres

Duda

Gehlen

et al. 2015

Scandinavian Med Sci Sports

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“…The rehabilitation of ruptured Achilles tendons includes varying loading programs, albeit without a real consensus with regards to the magnitude and when to initiate the loading . Intriguingly, despite extensive rehabilitation efforts, muscle weakness can persist for a considerable time after surgery and may even persist decade later . This muscle weakness has been attributed to a reduction in muscle cross‐sectional area (CSA), and the persistent muscle atrophy has prompted an emphasis on early mobilization following the repair of the ruptured tendon .…”

Section: Introductionmentioning

confidence: 99%

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

et al. 2019

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We examined muscle function, muscle architecture, and tendon length bilaterally in persons who experience a functional deficit 2 years after an Achilles tendon rupture. Eleven persons were investigated on the injured compared with the uninjured side 47 ± 7 months (mean ± SD) after a tendon rupture. Heel‐rise data, plantar flexion strength, tendon resting angle 3D MRI‐determined tendon length and muscle cross‐sectional area, ultrasound‐determined fascicle length, and pennation angle were obtained. The heel‐rise test yielded reduced max height (32%), number of repetitions (54%), and work performed (61%), P < .001. Plantar flexion strength was impaired (P < .001) with the knee in extension (20%‐42%) and flexion (29%‐39%). Muscle cross‐sectional area was reduced for both the soleus (36%) and gastrocnemius muscles (46%; P < .001). Both the soleus tendon (55%) and the gastrocnemius tendon (14%) were longer (P < .001), and the fascicle length of the medial gastrocnemius was substantially reduced (18%; P < .001). The difference in heel‐rise height correlated to that of the gastrocnemius tendon elongation, r = .66, P < .05, but not soleus tendon elongation. These data show that a functional deficit after an Achilles tendon rupture is associated with an elongated soleus and gastrocnemius tendon along with a reduced soleus and gastrocnemius muscle cross‐sectional area and gastrocnemius fascicle length.

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“…Tendons and ligaments are collagenous fibrous tissues, which connect bones and muscles, and transmit mechanical forces efficiently . Tendon and ligament injuries are treated surgically or non‐surgically, and both methods yielded overall good recovery rates . However, repaired tendon tissues are often histologically unorganized and usually have inferior mechanical strength, which can lead to re‐rupture .…”

mentioning

confidence: 99%

Transcription factor Mohawk controls tenogenic differentiation of bone marrow mesenchymal stem cells in vitro and in vivo

Otabe

Nakahara

Hasegawa

et al. 2014

Journal Orthopaedic Research

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Purpose Mohawk homeobox (MKX) has been demonstrated as a tendon/ligament specific transcription factor. The aim of this study was to investigate the role of MKX in ligament/tenogenic differentiation of bone marrow derived mesenchymal stem cells (BMMSCs). Methods Human BMMSCs were treated with 50 ng/ml BMP-12 or transduced with MKX or scleraxis (SCX) adenoviral vector. Gene expression analysis was performed by quantitative reverse transcribed polymerase chain reaction (qRT-PCR). Rat BMMSCs were seeded in a collagen scaffold and transplanted into a rat Achilles tendon defect model. Tenogenesis related gene expressions and histological features were analyzed. Results BMP-12 induced tenogenesis in BMMSCs as indicated by increased COL1a1, TNXB, DCN and SCX mRNA and MKX expression increased simultaneously. Rat BMMSCs enhanced defect repair and were still detectable 3 weeks after transplantation. Increased expressions of COL1a1, TNC and TNMD in vivo were also correlated with upregulated MKX. Adenoviral MKX promoted expression of COL1a1, TNXB and TNMD in BMMSCs. Conclusions This study demonstrated that MKX gene expression is enhanced during the tenogenic differentiation of BMMSCs in vitro and in vivo, and the adenoviral overexpression of MKX increases tendon extracellular matrix gene expression and protein production. Thus, MKX is a key factor for tenogenic differentiation of MSCs.

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Long-term biomechanical outcomes after Achilles tendon ruptures

Abstract: Clinical scores do not predict biomechanical outcomes. Clinically measured MCC is a good predictor of PPFT and POFF and can easily be used in clinical practice. Relative POFF in side comparison as well as per body weight favours surgical treatment.

Cited by 44 publications

References 40 publications

Increased unilateral tendon stiffness and its effect on gait 2–6 years after Achilles tendon rupture

Increased unilateral tendon stiffness and its effect on gait 2–6 years after Achilles tendon rupture

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

Transcription factor Mohawk controls tenogenic differentiation of bone marrow mesenchymal stem cells in vitro and in vivo

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