Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture

Agres, Alison N.; Gehlen, Tobias; Arampatzis, Adamantios; Taylor, William R.; Duda, Georg N.; Manegold, Sebastian

doi:10.1016/j.gaitpost.2018.03.007

Cited by 17 publications

(28 citation statements)

References 26 publications

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“…Eleven individuals (10 male, 1 female) were included in the rupture group and 10 individuals (5 male, 5 female) were included in the control group. There were no significant differences between groups with regard to body mass index (rupture: 25…”

Section: Participant Demographicsmentioning

confidence: 90%

“…Typical biomechanics analysis has been largely limited to comparing an instantaneous peak metric (e.g., power) between injured and uninjured groups. While this is informative and has been sensitive to differences between ruptured and uninjured sides in the population of individuals with Achilles tendon rupture, it only accounts for a moment in time. Recently, a constituent lower extremity work (CLEW) approach was proposed to calculate relative work done by each of the lower extremity constituents (hip, knee, ankle, distal foot) over the course of an entire cyclic task and graphically depict the data .…”

mentioning

confidence: 99%

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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: Participant Demographicsmentioning

confidence: 90%

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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“…Following injury, ATR patients exhibit lasting functional deficits in plantarflexor strength (Mullaney et al, 2006;Metz et al, 2009;Olsson et al, 2011;Agres et al, 2015;Heikkinen et al, 2017b) and in athletic performance (Amin et al, 2013;Trofa et al, 2017). Such deficits in function are likely due to lasting structural changes in both tissues of the affected plantarflexor muscle-tendon unit (MTU) (Heikkinen et al, 2017b), which presents with a longer tendon length (Kangas et al, 2007;Rosso et al, 2013;Agres et al, 2018) and triceps surae muscle atrophy, regardless of either surgical or conservative treatment (Rosso et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Weight bearing soon after initial ATR treatment has been seen as an ideal rehabilitative treatment for patients (Brumann et al, 2014). However, various forms of exercise and mobilization interventions in ATR rehabilitation do not appear to significantly improve functional outcomes (Suchak et al, 2008;Agres et al, 2018;Eliasson et al, 2018;Kastoft et al, 2019), particularly with regards to the recovery of plantarflexor strength on the affected limb. Considering the main contribution of the triceps surae muscle to plantarflexion performance, comparably limited work has investigated structural changes in the triceps surae muscles following ATR.…”

Section: Introductionmentioning

confidence: 99%

Muscle Fascicles Exhibit Limited Passive Elongation Throughout the Rehabilitation of Achilles Tendon Rupture After Percutaneous Repair

et al. 2020

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Achilles tendon rupture (ATR) results in long-term functional and structural deficits, characterized by reduced ankle mobility and plantarflexor muscle atrophy. However, it remains unclear how such functional impairments develop after surgical repair. While it is known that this injury negatively affects the tendon's function, to date, limited work has focused on the short-term effect of ATR on the structure of the muscles in series. The aim of this study was to characterize changes in medial gastrocnemius architecture and its response to passive lengthening during the post-surgical rehabilitative period following ATR. Both injured and contralateral limbs from 10 subjects (1 female, BMI: 27.2 ± 3.9 kg/m 2 ; age: 46 ± 10 years) with acute, unilateral ATR were assessed at 8, 12, and 16 weeks after percutaneous surgical repair. To characterize the component tissues of the muscle-tendon unit, resting medial gastrocnemius muscle thickness, fascicle length, and pennation angle were determined from ultrasound images with the ankle in both maximal plantarflexion and dorsiflexion. The ankle range of motion (ROM) was determined using motion capture; combined ultrasound and motion capture determined the relative displacement of the musculotendinous junction (MTJ) of the AT with the medial gastrocnemius. The ATR-injured gastrocnemius muscle consistently exhibited lower thickness, regardless of time point and ankle angle. Maximal ankle plantarflexion angles and corresponding fascicle lengths were lower on the injured ankle compared to the contralateral throughout rehabilitation. When normalized to the overall ankle ROM, both injured fascicles and MTJ displacement exhibited a comparably lower change in length when the ankle was passively rotated. These results indicate that when both ankles are passively exposed to the same ROM following ATR surgery, both ipsilateral Achilles tendon and gastrocnemius muscle fascicles exhibit limited lengthening compared to the contralateral MTU tissues. This appears to be consistent throughout the rehabilitation of gait, suggesting that current post-operative rehabilitative exercises do not appear to induce muscle adaptations in the affected MTU.

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No effects of early functional mobilization on gait patterns after acute Achilles tendon rupture repair

Aufwerber

Naili

Silbernagel

et al. 2021

Journal Orthopaedic Research

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This study aimed to compare recovery of gait patterns in patients treated with early functional mobilization (EFM) or standard treatment (ST) after Achilles tendon rupture repair. Second, this study aimed to explore associations between gait patterns and tendon elongation and calf muscle atrophy, respectively. Forty-seven patients (12 females), mean age 38.7 (7.3) years, were included. Patients were postoperatively randomized to EFM (n = 29), including immediate weightbearing and ankle motion for 6 weeks, or ST (n = 18), with 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis. Three-dimensional gait analyses were performed at 8 weeks and 6 months postoperatively to evaluate ankle and knee kinematics and kinetics.Ultrasound imaging was performed to assess tendon length and calf muscle atrophy. At 8 weeks, there were no significant group differences in ankle and knee kinematics and kinetics, while side-to-side differences between injured and uninjured side were present within both groups. At 6 months, the ST group exhibited higher generating ankle power and greater peak moments in ankle and knee compared to the EFM group. In both groups, peak ankle dorsiflexion angle was greater on the injured side compared to the uninjured side. No correlations were found between ankle joint gait deviations and degree of tendon elongation or muscle atrophy. Clinical significance: The accelerated rehabilitation regimen with EFM did not result in a more symmetrical gait pattern. The gait pattern deviations in the ankle joint were not related to the degree of muscle atrophy or tendon elongation.

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Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture

Cited by 17 publications

References 26 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

Muscle Fascicles Exhibit Limited Passive Elongation Throughout the Rehabilitation of Achilles Tendon Rupture After Percutaneous Repair

No effects of early functional mobilization on gait patterns after acute Achilles tendon rupture repair

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