Neuromechanical Modulation of the Achilles Tendon During Bilateral Hopping in Patients with Unilateral Achilles Tendon Rupture, Over 1 Year After Surgical Repair

Oda, Hiroyuki; Sano, Kanae; Kunimasa, Yoko; Komi, Paavo V.; Ishikawa, M.

doi:10.1007/s40279-016-0629-3

Cited by 25 publications

(37 citation statements)

References 34 publications

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“…Similar to the present study, they reported increased amplitude of activity in the soleus and no differences between sides in the medial gastrocnemius. 23 The results of the present study further suggest that the lateral and medial gastrocnemii do not activate similarly in individuals with Achilles tendon rupture, supporting continued investigation of the individual contributions of each of these muscles. Decreases in medial gastrocnemius but not lateral gastrocnemius cross sectional area further support the notion that the gastrocnemii are not affected by Achilles tendon rupture in the same way and should be considered separately.…”

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

“…A prior study by Oda et al, investigated side to side differences in soleus and medial gastrocnemius amplitude of activation during a bilateral hopping task. Similar to the present study, they reported increased amplitude of activity in the soleus and no differences between sides in the medial gastrocnemius . The results of the present study further suggest that the lateral and medial gastrocnemii do not activate similarly in individuals with Achilles tendon rupture, supporting continued investigation of the individual contributions of each of these muscles.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to increases in metabolic activity, the gastrocnemius has been found to increase activation during the stance phase of gait suggested to be in response to tendon lengthening . Medial gastrocnemius activity has also been suggested to relate to tendon mechanical properties during a bilateral jumping task …”

mentioning

confidence: 99%

“…22 Medial gastrocnemius activity has also been suggested to relate to tendon mechanical properties during a bilateral jumping task. 23 Despite these findings, there are limitations innate in the methodologies used in the available literature. Typical biomechanics analysis has been largely limited to comparing an instantaneous peak metric (e.g., power) between injured and uninjured groups.…”

mentioning

confidence: 99%

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Lower extremity work along with triceps surae structure and activation is altered with jumping after Achilles tendon repair

Zellers¹,

Marmon²,

Ebrahimi

et al. 2019

Journal Orthopaedic Research

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Achilles tendon rupture leads to long term plantar flexor deficits. The purpose of this study was to describe changes in jumping biomechanics along with triceps surae structure and activation in individuals after Achilles repair. Eleven individuals 1–3 years following Achilles repair and 10 healthy controls were included. Kinetics and kinematics, analyzed using a constituent lower extremity work (CLEW) approach, and muscle activity using surface electromyography (EMG) were collected during a unilateral hopping task. Triceps surae myotendinous structure was assessed using ultrasound imaging. There were no differences in jump height, absolute limb work, or cost of transport between groups. During takeoff, the knee did more (p < 0.001) and ankle did less concentric work (p < 0.001), and lateral gastrocnemius rate of rise was higher (p = 0.02) on the ruptured side. During landing, the knee did more eccentric work (p = 0.033) and lateral gastrocnemius (p = 0.003) and soleus (p = 0.02) activation amplitude prior to landing was higher on the ruptured side. Individuals after Achilles tendon repair shift work toward the knee and alter muscle recruitment. Differences in lateral gastrocnemius activity may indicate that it is well‐situated to generate power during takeoff and assist in landing with the soleus. The lack of change in muscle activity and decreased cross sectional area of the medial gastrocnemius may suggest that this muscle atrophies and does not accommodate to the hopping task. Clinical Significance: Proximal lower extremity strengthening along with emphasizing medial gastrocnemius and soleus activation during the recovery of patients with Achilles tendon repair may be rehabilitative targets for improved jumping performance. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Lower extremity work along with triceps surae structure and activation is altered with jumping after Achilles tendon repair

Zellers¹,

Marmon²,

Ebrahimi

et al. 2019

Journal Orthopaedic Research

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Impact of seated and standing positions on triceps surae muscle activation in unilateral Achilles tendon rupture

2019

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Heel rises are commonly used in the rehabilitation of individuals following Achilles tendon rupture; however, the impact of tendon elongation on triceps surae activation in seated versus standing positions has not been investigated. The purpose of this study was to investigate changes in triceps surae activation during seated compared to standing heel rises in individuals with Achilles tendon rupture and its relationship to tendon elongation. Ten individuals with a history of Achilles tendon rupture were included in this study. Muscle activity using electromyography was examined during a heel rise task in seated (unilateral) and standing (bilateral) positions. Soleus activity was not significantly different between sitting and standing on both the ruptured and uninjured side. On the ruptured, side there were no differences in medial or lateral gastrocnemius activity between sitting and standing; however, on the uninjured side medial and lateral gastrocnemius activity was lower in sitting compared to standing. The results of this study suggest that neuromuscular changes in triceps surae activation occur following Achilles tendon rupture. The seated heel rise position can be used to strengthen all muscles of the triceps surae and is useful when the patient is unable to perform a standing heel rise.

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Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes

Zellers

Cortés

Pohlig

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose Optimizing tendon structural recovery during the first 12 weeks after Achilles tendon rupture is a prime target to improve patient outcomes, but a comprehensive understanding of biomarkers is needed to track early healing. The purpose of this study was to observe healing of tendon structure over time using ultrasound‐based, tendon‐specific measures and to identify relationships between tendon structural characteristics and clinical measures of gait and strength. Methods Twenty‐seven participants (21 males, mean (SD) age 39 (11) years) were assessed at 4, 8, 12, and 24 weeks after injury or surgery using ultrasound imaging techniques. Gait analysis and strength testing were added at the later time points. Results Ruptured tendons had significantly lower dynamic shear modulus (p < 0.001), greater tendon cross‐sectional area (p < 0.001), and greater length (p < 0.001) than the uninjured side. Dynamic shear modulus, cross‐sectional area, and length were found to increase over time (p < 0.01). Tendon structure at 4 weeks post‐injury [cross‐sectional area symmetry (r = 0.737, p = 0.002) and dynamic shear modulus (r = 0.518, p = 0.040)] related to stance phase walking symmetry at 24 weeks. Conclusions Tendon structure assessed by ultrasound imaging changes over the first 24 weeks of healing after Achilles tendon rupture, suggesting it could be used as a biomarker to track tendon healing early in recovery. Additionally, tendon structure within the first 12 weeks relates to later walking gait and heel‐rise symmetry, which may indicate that tendon structure could have prognostic value in the care of these patients. This study's clinical relevance is in its support for using ultrasound imaging to assess early patient healing and prognosticate later patient outcomes after Achilles tendon rupture. Level of evidence Level 2, prospective cohort prognostic study.

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Neuromechanical Modulation of the Achilles Tendon During Bilateral Hopping in Patients with Unilateral Achilles Tendon Rupture, Over 1 Year After Surgical Repair

Cited by 25 publications

References 34 publications

Lower extremity work along with triceps surae structure and activation is altered with jumping after Achilles tendon repair

Lower extremity work along with triceps surae structure and activation is altered with jumping after Achilles tendon repair

Impact of seated and standing positions on triceps surae muscle activation in unilateral Achilles tendon rupture

Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes

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