Muscle-tendon morphomechanical properties of non-surgically treated Achilles tendon 1-year post-rupture

Khair, Ra'ad M.; Stenroth, Lauri; Cronin, Neil J.; Reito, Aleksi; Paloneva, Juha; Finni, Taija

doi:10.1016/j.clinbiomech.2021.105568

Cited by 14 publications

(17 citation statements)

References 50 publications

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“…As previously shown in other studies, 10,15,18 the contribution of flexor hallucis longus muscles and of the soleus can change after AT ruptures. Furthermore, calf muscle trophism in the operated limb as well as muscle maximal voluntary contraction remain significantly lower long term after the injury 18,30 ; collectively, these factors can contribute to different muscle activity patterns. The different contribution of the plantarflexor muscles cannot be distinguished by the tensiometer that measures AT wave speed.…”

Section: Discussionsupporting

confidence: 80%

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Shear Wave Tensiometry Can Detect Loading Differences Between Operated and Unaffected Achilles Tendon

Schneebeli,

Barbero,

Filardo

et al. 2023

Foot Ankle Int.

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Background: The clinically relevant healing process of a ruptured and repaired Achilles tendon (AT) can last more than a year. The purpose of this cross-sectional study was to test if shear wave tensiometry is able to detect AT loading changes between a surgically managed AT rupture versus the unaffected contralateral tendon. Our secondary aims were to evaluate differences in mechanical properties when measured with myotonometry and morphological properties of the tendons measured with ultrasonographic imaging. Methods: Twenty-one patients with surgically treated AT ruptures were investigated 12-37 months after surgery. Tendon load was measured using a shear wave tensiometer composed of an array of 4 accelerometers fixed on the tendon. Shear wave speed along the Achilles tendon was evaluated at different levels of ankle torque for both the operated and the unaffected side. Mechanical properties of the tendons were evaluated using MyotonPRO and morphological properties using ultrasonographic imaging. Friedman test was used to assess differences in AT wave speed, stiffness, thickness, and cross-sectional area between the operated and the unaffected tendon. Results: We found a significant shear wave speed difference between sides at every ankle joint torque ( P < .05) with a large effect size for the lowest ankle torque and small to medium effect sizes for higher ankle torque. Stiffness, thickness, and cross-sectional area of the operated tendon remained significantly higher compared to the unaffected side. Conclusion: In this cohort, we found that shear wave tensiometry can detect differences between operated and unaffected AT during a standardized loading procedure. The shear wave speed along the operated tendon, as well as the mechanical and morphologic properties, remains higher for 1-3 years after a rupture. Level of Evidence: Level III, case-control study.

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Section: Discussionsupporting

confidence: 80%

“…Previous studies showed greater tendon resting length 1,18,39 in the operated tendon compared to the unaffected side. However, the tendon resting length was not assessed in this study, and therefore we cannot establish whether tendon length influences shear wave speed.…”

Section: Discussionmentioning

confidence: 85%

Shear Wave Tensiometry Can Detect Loading Differences Between Operated and Unaffected Achilles Tendon

Schneebeli,

Barbero,

Filardo

et al. 2023

Foot Ankle Int.

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“…As expected, in the injured limb of ATR patients, we found much lower MVC torque and lower maximal displacement and strain compared to the non-injured leg. Nonetheless, the same observation of larger displacement in FAS than MTJ in both limbs confirms that even in cases where the properties and interaction behaviour of the muscle-aponeurosis-tendon system are dramatically altered (Khair et al 2022 ; Peng et al 2019 ), the FAS method still results in exaggerated estimates of MTJ displacement. Regarding strain, there was no statistically significant interaction between tracking location and contraction level, suggesting that the difference in strain does not depend on contraction intensity.…”

Section: Discussionsupporting

confidence: 61%

“…However, in the present study we focused on MG MTJ displacement and strain, and we found similar results to those typically reported in individuals who have never suffered an ATR. Furthermore, we previously found in the same patient cohort that while the injured limb had lower plantarflexion strength and a longer tendon length, stiffness was not different between limbs (Khair et al 2022 ). As a limitation it should be noted that we examined proximal–distal displacement and strain in two dimensions, although muscle–tendon junction shape may change 3-dimensionally (Farris et al 2013 ) and rotate laterally along with the muscle (Hodgson et al 2006 ).…”

Section: Discussionmentioning

confidence: 84%

“…due to Achilles tendon rupture (ATR), alter the effect of different tracking locations. For example, ATR may lead to an increase in Achilles tendon length after operative (Heikkinen et al 2017 ) and conservative management (Khair et al 2022 ), a shortening of calf muscle fascicles, and a decrease in aponeurosis stiffness (Peng et al 2019 ) in the injured limb. These changes could in turn affect tendon lengthening behaviour during contraction.…”

Section: Introductionmentioning

confidence: 99%

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Tendon length estimates are influenced by tracking location

et al. 2022

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Purpose Measurement of medial gastrocnemius (MG) tendon length using ultrasonography (US) requires the muscle–tendon junction (MTJ) to be located. Previously, the MG MTJ has been tracked from different proximo-distal locations near the MTJ, which could influence estimates of tendon length change due to the different characteristics of the aponeurosis and tendon. We used US to evaluate the effect of tracking point location on MG MTJ displacement during maximal and submaximal (10, 20 and 30% of the non-injured maximal) isometric plantar flexion contractions. Methods Displacement behaviour of MTJ was tracked from (1) the exact MTJ; and (2) from an insertion point of a muscle fascicle on the aponeurosis 1.3 ± 0.6 cm proximal to the MTJ, in both limbs of patients with unilateral Achilles tendon rupture (ATR) (n = 22, 4 females, 42 ± 9 years, 177 ± 9 cm, 79 ± 10 kg). Results In the non-injured limb, displacement (1.3 ± 0.5 cm vs. 1.1 ± 0.6 cm) and strain (6.7 ± 2.8% vs. 5.8 ± 3.3%) during maximal voluntary contraction were larger when tracking a point on the aponeurosis than when tracking the MTJ (both p < 0.001). The same was true for all contraction levels, and both limbs. Conclusion Tracking a point on the aponeurosis consistently exaggerates estimates of tendon displacement, and the magnitude of this effect is contraction intensity-dependent. When quantifying displacement and strain of the Achilles tendon, the MTJ should be tracked directly, rather than tracking a surrogate point proximal to the MTJ. The latter method includes part of the aponeurosis, which due to its relative compliance, artificially increases estimates of MTJ displacement and strain.

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Medial gastrocnemius muscle fascicle function during heel-rise after non-operative repair of Achilles tendon rupture

Dijk

Khair

Sukanen

et al. 2023

Clinical Biomechanics

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Muscle-tendon morphomechanical properties of non-surgically treated Achilles tendon 1-year post-rupture

Cited by 14 publications

References 50 publications

Shear Wave Tensiometry Can Detect Loading Differences Between Operated and Unaffected Achilles Tendon

Shear Wave Tensiometry Can Detect Loading Differences Between Operated and Unaffected Achilles Tendon

Tendon length estimates are influenced by tracking location

Medial gastrocnemius muscle fascicle function during heel-rise after non-operative repair of Achilles tendon rupture

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