Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture

2017 ◽  
Vol 99A (18) ◽  
pp. 1509-1515 ◽  
Author(s):  
Juuso Heikkinen ◽  
Iikka Lantto ◽  
Juuso Piilonen ◽  
Tapio Flinkkilä ◽  
Pasi Ohtonen ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Muscle Atrophy ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Calf Muscle ◽  
Tendon Length

Changes in Tendon Elongation and Muscle Atrophy Over Time After Achilles Tendon Rupture Repair: A Prospective Cohort Study on the Effects of Early Functional Mobilization

2020 ◽  
Vol 48 (13) ◽  
pp. 3296-3305 ◽  
Author(s):  
Susanna Aufwerber ◽  
Gunnar Edman ◽  
Karin Grävare Silbernagel ◽  
Paul W. Ackermann
Keyword(s):  
Patient Outcome ◽  
Cohort Study ◽  
Achilles Tendon ◽  
Muscle Atrophy ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Calf Muscle ◽  
Control Group ◽  
Tendon Elongation ◽  
Over Time

Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated with EFM or standard treatment after ATR repair. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study included 86 patients (20 women) with ATR repair who had a mean (SD) age of 39.3 (8.2) years and were part of a larger prospective randomized controlled trial. Patients were postoperatively randomized to immediate postoperative weightbearing and ankle motion (EFM group) or to immobilization in a below-knee plaster cast for 2 weeks (control group). Patient-reported and functional outcomes were assessed at 6 and 12 months with the Achilles Tendon Total Rupture Score and the heel-rise test for endurance. At 2 and 6 weeks and 6 and 12 months postoperatively, B-mode ultrasound imaging was performed to assess the length and cross-sectional area (CSA) of the Achilles tendon, the gastrocnemius CSA, as well as the thickness of soleus. Results: The Achilles Tendon Total Rupture Score for the EFM and control groups were 65.8 (18.7) and 56.8 (20.1; P = .045), respectively, at 6 months and 79.6 (15.8) and 78.9 (17.2; P = .87), respectively, at 12 months. At 2 weeks, tendon elongation was significantly more pronounced in the EFM group as compared with the control group (mean side-to-side difference, 1.88 cm vs 0.71 cm; P = .005). Subsequently, tendon elongation increased in the control group while it decreased in the EFM group so that at 6 and 12 months no significant differences between groups were found. Mean Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the EFM group (n = 55) and 1.67 (0.92) cm for the control group (n = 27), with a mean difference of 0.06 cm (95% CI, 0.54 to –0.42; P = .80). Achilles tendon CSA and calf muscle atrophy displayed no significant differences between the groups; however, significant changes were demonstrated over time ( P ≤ .001) in both groups. Conclusion: EFM results in more Achilles tendon elongation at early healing, but this difference subsides over time. EFM does not seem to affect patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy. Registration: NCT02318472 (ClinicalTrials.gov identifier).

scholarly journals Calf Muscle Atrophy and Achilles Tendon Elongation After Acute Achilles Tendon Rupture

2017 ◽  
Vol 33 (10) ◽  
pp. e129-e130 ◽  
Author(s):  
Juuso Heikkinen ◽  
Iikka Lantto ◽  
Tapio Flinkkila ◽  
Pertti Siira ◽  
Vesa Laine ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Muscle Atrophy ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Calf Muscle ◽  
Tendon Elongation

scholarly journals Use of ankle resting angle as a surrogate for tendon elongation in individuals following Achilles tendon rupture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Heather Gotha ◽  
Jennifer Zellers ◽  
Karin Silbernagel
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Plantar Flexors ◽  
Cross Sectional ◽  
Tendon Length ◽  
Tendon Elongation ◽  
The Relationship

Category: Ankle, Sports Introduction/Purpose: Tendon elongation is associated with poor functional outcome in individuals after Achilles tendon rupture. While imaging modalities are reliable to measure Achilles tendon length, alternative time- and cost-effective measures are of interest. The resting angle of the ankle in prone both with knee extended1 and knee flexed2 have been used in the literature as surrogates for measuring Achilles elongation, however, their relationship to tendon length is not well-established. The purpose of this study is to validate the ankle resting angle as a measure of tendon elongation and examine the relationship of ankle resting angle to tendon elongation and calf strength. Methods: Individuals following unilateral Achilles tendon rupture, treated surgically, were included in this cross-sectional study. Individuals were excluded if they had deep wound infection or lumbar radiculopathy affecting the ankle plantar flexors. Ankle resting angle with knee extended and knee flexed to 90 degrees was measured using a digital inclinometer positioned on the lateral, plantar surface of the foot. Relative resting angle was calculated by subtracting the uninjured from the injured side. Tendon length to gastrocnemius was measured using B mode, extended field of view ultrasound imaging3 (tendon elongation = ruptured- uninjured). Calf strength was measured using the heel-rise test4. Limb symmetry indexes (LSI) were calculated (ruptured/uninjured sidex100) for total work performed on the heel-rise test. Results: Twenty-five individuals, a mean(SD) age of 44.2(13.6) years and mean(SD) of 22.5(39.1) months post-rupture, were included in this study. Mean(SD) relative resting angle with knee flexed was -5.4(6.4)° and mean (SD) relative resting angle with knee extended was -6.7(8.8)°. Mean(SD) tendon elongation was 1.56(1.20)cm. Mean(SD) heel-rise test work LSI was 45.8(23.8)%. Ankle resting angle with knee flexed related to elongation (r = -0.452, p = 0.027) and heel-rise test work LSI (r = 0.591, p=0.006). Ankle resting angle with knee extended related to elongation (r=-0.528, p=0.008) (Figure 1) but not heel-rise test work LSI. Conclusion: The results of this study suggest that ankle resting angle with knee extended and flexed are related to tendon elongation, however, calf strength also has a relationship to resting angle with knee flexed. This suggests that the ability of the calf to put passive tension on the foot is also a component of resting angle. The relationship between tendon elongation and resting angle with knee flexed may have been limited by methodological concerns, as tendon length was measured with the participant positioned with knees extended.

Recovery of Calf Muscle Strength Following Acute Achilles Tendon Rupture Treatment

2009 ◽  
Vol 2 (5) ◽  
pp. 219-226 ◽  
Author(s):  
Roderik Metz ◽  
Geert J. M. G. van der Heijden ◽  
Egbert-Jan M. M. Verleisdonk ◽  
Rob Tamminga ◽  
Christiaan van der Werken
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Calf Muscle

Repair of Chronic Complete Traumatic Rupture of the Common Calcaneal Tendon in a Dog, Using a Fascia Lata Graft

2000 ◽  
Vol 13 (02) ◽  
pp. 104-108 ◽  
Author(s):  
J. Shani ◽  
R. Shahar
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Fascia Lata ◽  
Traumatic Rupture ◽  
Free Graft ◽  
Calcaneal Tendon ◽  
Tendon Length ◽  
The Common ◽  
Successful Repair

SummaryA 3-month-old male Cocker Spaniel was presented with the complaint of chronic right hind leg lameness. The owner described superficial trauma at the area of the hock, which was noticed immediately after delivery. History, habitus, physical examination, and radiography suggested rupture of the common calcaneal tendon. This report describes the successful repair of complete rupture of the common calcaneal tendon, with loss of tendon length, using a fascia lata free graft.The following case report describes the successful repair of a chronic complete traumatic rupture of all components of the Achilles tendon with loss of tendon length, in a 3-month-old puppy, using a tensor fascia lata free graft. Due to the young age of the animal no internal fixation was used to protect the graft, and external coaptation was used instead. Achilles tendon rupture is a relatively common injury in humans and many methods of repair are reported for acute and chronic ruptures. The medical and veterinary literature is reviewed with regard to the pathogenesis and treatment of Achilles tendon rupture.

scholarly journals Achilles Tendon Resting Angle Relates to Tendon Length and Function

2017 ◽  
Vol 39 (3) ◽  
pp. 343-348 ◽  
Author(s):  
Jennifer A. Zellers ◽  
Michael R. Carmont ◽  
Karin Grävare Silbernagel
Keyword(s):  
Mechanical Properties ◽  
Achilles Tendon ◽  
Test Performance ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Shear Wave Elastography ◽  
Level Of Evidence ◽  
Tendon Length ◽  
Tendon Elongation ◽  
The Relationship

Background: Following Achilles tendon rupture, tendon elongation leads to long term deficits in calf function. A surrogate measure of Achilles tendon length, Achilles tendon resting angle (ATRA), has been described but has not been validated against length measured using ultrasound. Therefore, the purpose of this study was to validate the ATRA against ultrasound. Secondarily, this study aimed to identify the relationship of other factors (tendon mechanical properties, heel-rise test performance) to the ATRA. Methods: Individuals following unilateral Achilles tendon rupture were included. ATRA was measured in knee flexed and extended positions. Tendon elongation was measured using extended field of view ultrasound imaging. Continuous shear wave elastography quantified tendon mechanical properties. The relationship between variables was tested using Spearman’s ρ. Subgroup analysis was used to compare subjects with less then or greater than 1 year following rupture. A total of 42 participants (with a mean of 18.2 months following rupture [SD = 35.9]) were included. Results: Tendon elongation related with relative ATRA with knee flexed (ρ = .491, P = .001) and knee extended (ρ = 0.501, P = .001) positions. In individuals greater than 1 year following rupture, relative ATRA with the knee flexed related to shear modulus (ρ = .800, P = .01) and total work on the heel-rise test (ρ = –.782, P = .008) relative to the uninjured side. Conclusion: Relative ATRA in both knee flexed and knee extended positions has a moderate relationship to tendon elongation within the first year following rupture. After 1 year, the relative ATRA with knee flexed may be a better indicator of tendon elongation and also related to tendon mechanical properties and heel-rise test performance. Level of Evidence: Level III, case-control study.

scholarly journals Impact of Physiotherapy on the Calf Muscle Torque Variability after Achilles Tendon Rupture

2020 ◽  
Vol 2 (5) ◽  
Author(s):  
Vaida Aleknavičiūtė ◽  
Rima Solianik ◽  
Dovilė Kielė ◽  
Laimutis Škikas ◽  
Nerijus Masiulis ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Maximal Voluntary Contraction ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Voluntary Contraction ◽  
Calf Muscle ◽  
Muscle Torque ◽  
Maximal Voluntary Contraction Torque ◽  
Flexion And Extension

It has been established that muscle torque variability determines movement stability during the task [1]. Calf muscle weakness, ankle range of motion reduction and postural misbalance are common pathological limitations after Achilles tendon rupture (ATR). Most studies analyse rehabilitation influence for muscle strength and body balance, but there is a lack of information about calf muscle torque variability. The aim of the study was to determine ankle plantar flexion and dorsal flexion muscle maximal voluntary contraction torque and variability Q. Organization and methods. We measured five males, (aged 29 ± 6) after 6.5 – week surgery of ATR. Participants performed isometric ankle flexion and extension force with injured and non-injured legs. Muscles maximal voluntary contraction (MVC) torque and torque variability were measured at –15°; 0°; 15° angles. The variability of target force was 20% of MVC torque. Rehabilitation programme consisted of balance, muscle strength and stretching exercises. Calf muscle MVC torque and variability were observed before and after 8-week rehabilitation. The results of the research. We determined that after physiotherapy the injured and the non-injured leg isometric ankle flexion and extension muscle MVC torque increased and muscle torque variability decreased.Keywords: muscle torque variability, isometric maximal voluntary contraction torque, rehabilitation suformavimas.

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