Separation of Tendon Ends After Achilles Tendon Repair: A Prospective, Randomized, Multicenter Study

Mortensen, Niels Henrik Maagaard; Saether, Jan; Steinke, Martin Søe; Staehr, H; Mikkelsen, Soren Sondergård

doi:10.3928/0147-7447-19920801-06

Cited by 70 publications

(26 citation statements)

References 8 publications

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“…This was supported by the high ATRS values at 6 and 12 months. Achilles tendon lengthening with tendon end separation has been reported to occur primarily during the first 4 months after surgery [6,9,17]. Of clinical relevance, the clinical outcome has been reported to correlate with the degree of tendon elongation [6,8].…”

Section: Discussionmentioning

confidence: 99%

Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture

Suydam

Buchanan

Manal

et al. 2013

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. Method The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 month post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during over-ground walking. Results Achilles lengths at 6 and 12 months post-surgery were significantly longer (p < 0.05) on the involved side compared to the uninvolved side but there were no side to side differences in the healthy controls. The integrated EMG (iEMG) of the involved side was significantly higher than the uninvolved side in the lateral gastrocnemius at 6 months and for the medial gastrocnemius at 12 months in the patients with Achilles tendon rupture; no side to side difference was found in the healthy controls. The triceps surae muscles’ activations were fair to moderately correlated to the Achilles lengths (0.38 < r < 0.52). Conclusions The increased Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength an important treatment goal appears to be to minimize tendon elongation. Level of evidence Prognostic prospective case series. Level IV.

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Section: Discussionmentioning

confidence: 99%

Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture

Suydam

Buchanan

Manal

et al. 2013

Knee Surg Sports Traumatol Arthrosc

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“…Excessive tendon elongation and rerupture are also described as two of the reasons for surgical revision following ATR [14, 35]. Studies have demonstrated that after Achilles tendon repair, tendon ends may separate [19]. Kangas et al [8] have also shown that early motion resulted in a lesser degree of tendon separation than did immobilization after surgical treatment of an ATR.…”

Section: Discussionmentioning

confidence: 99%

A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture

Silbernagel

Nilsson-Helander

Thomeé

et al. 2009

Knee Surg Sports Traumatol Arthrosc

178

234

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Studies evaluating treatment effects on muscle function after an Achilles tendon rupture often use various tests for evaluating calf muscle strength. However, these tests rarely demonstrate the difference between treatment groups; therefore, new tests with a higher ability to detect possible differences in outcome are needed. The purpose of this study was to evaluate the validity and ability to detect differences in outcome of a heel-rise work test that would measure both the height of each heel-rise and the number of repetitions. Seventy-eight patients (65 men and 13 women) at a mean (standard deviation) age of 42 (9) years with Achilles tendon ruptures were included. The patients were evaluated with the new heel-rise test at 6 and 12 months after injury. The limb symmetry index (LSI = involved/uninvolved x 100) was calculated to determine the size of the difference in function between the injured and the uninjured side. The heel-rise height differed significantly between the injured and uninjured sides at the 6- and 12-month evaluations (P < 0.001). At the 6-month evaluation, the patients had achieved a mean LSI of 84% on the number of repetitions parameter but only a mean LSI of 61% on the work parameter. At the 12-month evaluation the mean, LSI of the heel-rise repetition parameter was 95%, indicating that the patients had fully recovered function, but on the work parameter the mean LSI was only 76%. The heel-rise work test in the present study has good validity and greater ability to detect differences between the injured and the uninjured sides than a test that measures only the number of heel-rise repetitions in patients with Achilles tendon rupture.

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“…However, we lacked measurements on tendon elongation before the 2-week follow-up, and a substantial amount of total tendon elongation could have occurred before bead insertion. 29,31 This study had some limitations. In the measurements of the material properties, a number of simplifying assumptions had to be made, such as tissue homogeneity, a consistent cross-sectional area along the tendon between the beads, and a linear load deformation relationship.…”

Section: Discussionmentioning

confidence: 95%

“…However, we lacked measurements on tendon elongation before the 2-week follow-up, and a substantial amount of total tendon elongation could have occurred before bead insertion. 29 , 31 …”

Section: Discussionmentioning

confidence: 99%

Early Tensile Loading in Nonsurgically Treated Achilles Tendon Ruptures Leads to a Larger Tendon Callus and a Lower Elastic Modulus: A Randomized Controlled Trial

et al. 2022

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Background: Early tensile loading improves material properties of healing Achilles tendon ruptures in animal models and in surgically treated human ruptures. However, the effect of such rehabilitation in patients who are nonsurgically treated remains unknown. Hypothesis: In nonsurgically treated Achilles tendon ruptures, early tensile loading would lead to higher elastic modulus 19 weeks after the injury compared with controls. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Between October 2015 and November 2018, a total of 40 nonsurgically treated patients with acute Achilles tendon rupture were randomized to an early tensile loading (loaded group) or control group. Tantalum bead markers were inserted percutaneously into the tendon stumps 2 weeks after the injury to allow high-precision measurements of callus deformation under mechanical testing. The loaded group used a training pedal twice daily to produce a gradual increase in tensile load during the following 5 weeks. Both groups were allowed full weightbearing in an ankle orthosis and unloaded range of motion exercises. Patients were followed clinically and via roentgen stereophotogrammetric analysis and computed tomography at 7, 19, and 52 weeks after the injury. Results: The mean ± standard deviation elastic modulus at 19 weeks was 95.6 ± 38.2 MPa in the loaded group and 108 ± 45.2 MPa in controls ( P = .37). The elastic modulus increased in both groups, although it was lower in the loaded group at all time points. Tendon cross-sectional area increased from 7 weeks to 19 weeks, from 231 ± 99.5 to 388 ± 142 mm2 in the loaded group and from 188 ± 65.4 to 335 ± 87.2 mm2 in controls ( P < .001 for the effect of time). Cross-sectional area for the loaded group versus controls at 52 weeks was 302 ± 62.4 mm2 versus 252 ± 49.2 mm2, respectively ( P = .03). Gap elongation was 7.35 ± 13.9 mm in the loaded group versus 2.86 ± 5.52 mm in controls ( P = .27). Conclusion: Early tensile loading in nonsurgically treated Achilles tendon ruptures did not lead to higher elastic modulus in the healing tendon but altered the structural properties of the tendon via an increased tendon thickness. Registration: NCT0280575 (ClinicalTrials.gov identifier).

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Separation of Tendon Ends After Achilles Tendon Repair: A Prospective, Randomized, Multicenter Study

Cited by 70 publications

References 8 publications

Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture

Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture

A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture

Early Tensile Loading in Nonsurgically Treated Achilles Tendon Ruptures Leads to a Larger Tendon Callus and a Lower Elastic Modulus: A Randomized Controlled Trial

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