The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial

Eliasson, Pernilla; Agergaard, Anne‐Sofie; Couppé, Christian; Svensson, René B.; Hoeffner, Rikke; Warming, Susan; Warming, Nichlas; Holm, Christina Enciso; Jensen, Mikkel; Krogsgaard, Michael; Kjær, Michael; Magnusson, S. Peter

doi:10.1177/0363546518781826

Cited by 94 publications

(135 citation statements)

References 56 publications

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“…Not surprisingly, the maximal height achieved during the heel‐rise test was substantially lower (32%) on the injured side, which corroborates that of several studies . It has been suggested that this deficit reflects an increase in tendon length, which is supported by the present data.…”

Section: Discussionsupporting

confidence: 93%

“…In the present study, the strength deficit was 29%‐39% with the knee in flexion, which primarily reflects that of the soleus muscles, and the deficit was 20%‐42% with the knee in extension, which also engages the gastrocnemius in addition to the soleus. These deficits are far greater than previously reported, albeit not surprising given the substantial differences in anatomical CSA (36%‐46%) and the fact that functional impairment was an inclusion criterion. The strength difference also likely contributes to the low ATRS scores in the group.…”

Section: Discussionmentioning

confidence: 53%

“…This is a within‐subject control study of persons with a prior unilateral Achilles tendon rupture: The injured side was compared with the uninjured side. A total of 96 persons who had previously undergone Achilles tendon rupture more than 2 years ago were contacted in writing: 49 treated conservatively (from the Danish Achilles tendon rupture database, Hvidovre Hospital) and 47 treated surgically (from Bispebjerg and Fredirskberg Hospital) . They were asked (a) if they experienced that the Achilles tendon injury still compromised their overall daily activities, including recreational activities, and (b) if they were unable to perform a heel‐rise of equal height when standing on one leg at the time.…”

Section: Methodsmentioning

confidence: 99%

“…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 . Intriguingly, despite extensive rehabilitation efforts, muscle weakness can persist for a considerable time after surgery and may even persist decade later .…”

Section: Introductionmentioning

confidence: 99%

“…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 …”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2019

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We examined muscle function, muscle architecture, and tendon length bilaterally in persons who experience a functional deficit 2 years after an Achilles tendon rupture. Eleven persons were investigated on the injured compared with the uninjured side 47 ± 7 months (mean ± SD) after a tendon rupture. Heel‐rise data, plantar flexion strength, tendon resting angle 3D MRI‐determined tendon length and muscle cross‐sectional area, ultrasound‐determined fascicle length, and pennation angle were obtained. The heel‐rise test yielded reduced max height (32%), number of repetitions (54%), and work performed (61%), P < .001. Plantar flexion strength was impaired (P < .001) with the knee in extension (20%‐42%) and flexion (29%‐39%). Muscle cross‐sectional area was reduced for both the soleus (36%) and gastrocnemius muscles (46%; P < .001). Both the soleus tendon (55%) and the gastrocnemius tendon (14%) were longer (P < .001), and the fascicle length of the medial gastrocnemius was substantially reduced (18%; P < .001). The difference in heel‐rise height correlated to that of the gastrocnemius tendon elongation, r = .66, P < .05, but not soleus tendon elongation. These data show that a functional deficit after an Achilles tendon rupture is associated with an elongated soleus and gastrocnemius tendon along with a reduced soleus and gastrocnemius muscle cross‐sectional area and gastrocnemius fascicle length.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 53%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2019

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Injectable bioactive glass/sodium alginate hydrogel with immunomodulatory and angiogenic properties for enhanced tendon healing

Zhu

et al. 2022

Bioengineering & Transla Med

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Tendon healing is a complex process involving inflammation, proliferation, and remodeling, eventually achieving a state of hypocellularity and hypovascularity. Currently, few treatments can satisfactorily restore the structure and function of native tendon. Bioactive glass (BG) has been shown to possess immunomodulatory and angiogenic properties. In this study, we investigated whether an injectable hydrogel fabricated of BG and sodium alginate (SA) could be applied to enhance tenogenesis following suture repair of injured tendon. We demonstrated that BG/SA hydrogel significantly accelerated tenogenesis without inducing heterotopic ossification based on histological analysis. The therapeutic effect could attribute to increased angiogenesis and M1 to M2 phenotypic switch of macrophages within 7 days post‐surgery. Morphological characterization demonstrated that BG/SA hydrogel partially reverted the pathological changes of Achilles tendon, including increased length and cross‐sectional area (CSA). Finally, biomechanical test showed that BG/SA hydrogel significantly improved ultimate load, failure stress, and tensile modulus of the repaired tendon. In conclusion, administration of an injectable BG/SA hydrogel can be a novel and promising therapeutic approach to augment Achilles tendon healing in conjunction with surgical intervention.

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Effects of tendon elongation on plantar pressure and clinical outcomes: A comparative analysis between open repair and minimally invasive surgery

Karlidag,

Bingol,

Kulakoglu

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to assess whether variances in Achilles tendon elongation are linked to dissimilarities in the plantar pressure distribution following two different surgical approaches for an Achilles tendon rupture (ATR).MethodsAll patients who were treated with open or minimally invasive surgical repair (MIS) and were over 2 years post their ATR were eligible for inclusion. A total of 65 patients with an average age of 43 ± 11 years were included in the study. Thirty‐five patients were treated with open repair, and 30 patients were treated with MIS. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and ATR Score (ATRS). Achilles tendon elongation was measured using axial and sagittal magnetic resonance imaging scans. Plantar pressure measurements for the forefoot, midfoot and hindfoot during gait were divided into percentages based on total pressure, measured in g/cm2 for each area.ResultsThe average AOFAS score was found ‘excellent’ (93 ± 2.8) in the MIS group, while it was found ‘good’ (87.4 ± 5.6) in the open repair group. In addition, the MIS group showed significantly superior ATRS scores (78.8 ± 7.4) compared to the open repair group (56.4 ± 15.4) (p < 0.001). The average tendon elongation in the MIS group was 11.3 ± 2 mm, while it was 17.3 ± 4.3 mm (p < 0.001) in the open repair group. While the open repair group showed significantly higher plantar pressure distribution in the initial contact and preswing phases compared to uninjured extremities, there was no significant difference between the uninjured extremities and the MIS group.ConclusionIn conclusion, the findings of this study demonstrated that minimally invasive surgery was associated with less tendon elongation, more proximity to the plantar pressure distributions of the uninjured extremity and superior clinical outcomes compared to open surgical repair. Therefore, minimally invasive surgery may be considered a more suitable option for acute Achilles tendon repair to achieve overall better outcomes.Level of EvidenceLevel III.

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The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial

Cited by 94 publications

References 56 publications

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

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

Injectable bioactive glass/sodium alginate hydrogel with immunomodulatory and angiogenic properties for enhanced tendon healing

Effects of tendon elongation on plantar pressure and clinical outcomes: A comparative analysis between open repair and minimally invasive surgery

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