Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments

Abstract

Treating ATRs nonsurgically with a functional rehabilitation protocol resulted in greater soleus muscle atrophy compared with surgical treatment. The mean Achilles tendon length was 19 mm longer after nonsurgical treatment than after the surgical treatment of ATRs. These structural changes partly explained the 10% to 18% greater calf muscle strength observed in patients treated with surgery compared with those treated nonsurgically. Registration: NCT02012803 ( ClinicalTrials.gov identifier).

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

“…The recovery time after an Achilles tendon rupture is typically several months, and irrespective of the initial treatment, complete functional outcome is often not reached . 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 .…”

“…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 .…”

“…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 . However, these efforts have not proven effective in counteracting the loss of muscle mass and associated function …”

“…The ruptured midportion Achilles tendon comprises tendon fascicles from both the gastrocnemii and the soleus muscles . However, tendon elongation in relation to Achilles tendon rupture has been defined as that pertaining the gastrocnemius and rarely that of the soleus, but never both simultaneously and never compared with the uninjured side. Therefore, it remains unknown to what extent the elongation may occur in the tendon associated with the soleus and gastrocnemius muscles.…”

Tendon end separation with loading in an Achilles tendon repair model: comparison of non-absorbable vs. absorbable sutures

“…This weakness has been associated with tendon elongation (Silbernagel et al, 2012). Operative repair of Achilles tendon ruptures leads to improved early outcome (Keating & Will, 2011), in terms of strength (Lantto et al, 2016; Willits et al, 2010) and functional activities (Olsson et al, 2011; Olsson et al, 2014) and reduced tendon elongation of 18.7 mm compared to non-operative treatment ( P  < 0.01) (Heikkinen et al, 2017) although lengthening (5 mm at 12 months, and 14.5 mm at 13 years) still occurs even in augmented repairs (Heikkinen et al, 2016; Pajala et al, 2009). …”