Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial

Okoroha, Kelechi R.; Ussef, Najib; Jildeh, Toufic R.; Khalil, Lafi S.; Hasan, Laith K; Bench, Carter; Zeni, Ferras; Eller, Erik B.; Moutzouros, Vasilios

doi:10.1177/0363546520909389

Cited by 39 publications

(36 citation statements)

References 20 publications

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“…In combination with the lower achievable height (HR_pos) and comparable values for the total distance, this suggests that the entire range of motion is shifted to more dorsiflexed position following AT rupture and repair. This is in line with the differences in maximum peak torque angle, and it further underlines the alteration of the triceps surae lever arm trajectories described following AT rupture [24,34]. In our view, this adds a novel facet to the interpretation of a functional and structural elongation of the muscle-tendon unit in AT repair.…”

Section: Heel-rise Testsupporting

confidence: 83%

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Midterm functional performance following open surgical repair of acute Achilles tendon rupture

Mauch²,

Heitner³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair. Materials and Methods This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. Results At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p < 0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing. Conclusion In summary, there are persisting functional deficits at > 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. Level of evidence III, retrospective cohort study

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Section: Heel-rise Testsupporting

confidence: 83%

“…In terms of patients' satisfaction, AT rupture is associated with a highly acceptable outcome averaging midterm Achilles Tendon Rupture Scores (ATRS) above 85/100 [23,24]. Neither rehabilitation scheme (accelerated vs. traditional) nor surgical vs. non-surgical treatment seem to have a significant advantage in the average patient [23,24].…”

Section: Introductionmentioning

confidence: 99%

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

Mauch²,

Heitner³

et al. 2021

Arch Orthop Trauma Surg

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“…The PROMIS instruments are already being used in the evaluation of Achilles tendon disorders. 1 , 22 …”

Section: Discussionmentioning

confidence: 99%

Validation of PROMIS Physical Function for Evaluating Outcome After Acute Achilles Tendon Rupture

Ochen

Guss

Houwert

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: There is increased demand for valid, reliable, and responsive patient-reported outcome measures (PROMs) to evaluate treatment for Achilles tendon rupture, but not all PROMs currently in use are reliable and responsive for this condition. Purpose: To evaluate the measurement properties of the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) compared with other PROMs used after treatment for acute Achilles tendon rupture. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A retrospective cohort study with a follow-up questionnaire was performed. All adult patients with an acute Achilles tendon rupture between June 2016 and June 2018 with a minimum 12-month follow-up were eligible for inclusion. Functional outcome was assessed using the PROMIS PF computerized adaptive test (CAT), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), FAAM–Sports, and Achilles Tendon Total Rupture Score (ATRS). Pearson correlation ( r) was used to assess the correlations between PROMs. Absolute and relative floor and ceiling effects were calculated. Results: In total, 103 patients were included (mean age, 44.7 years; 74% male); 82 patients (79.6%) underwent operative repair, while 21 patients (20.4%) underwent nonoperative management. The mean time between treatment and collection of PROMs was 25.3 months (range, 15-36 months). The mean scores were 55.4 ± 9.2 (PROMIS PF), 92.9 ± 12.2 (FAAM-ADL), 77.7 ± 22.9 (FAAM–Sports), and 83.0 ± 19.4 (ATRS). The ATRS was correlated with FAAM-ADL ( r = 0.80; 95% CI, 0.72-0.86; P < .001) and FAAM–Sports ( r = 0.86; 95% CI, 0.80-0.90; P < .001). The PROMIS PF was correlated with the FAAM-ADL ( r = 0.66; 95% CI, 0.53-0.75; P < .001), FAAM–Sports ( r = 0.65; 95% CI, 0.53-0.75; P < .001), and ATRS ( r = 0.69; 95% CI, 0.58-0.78; P < .001). The PROMIS PF did not show absolute floor or ceiling effects (0%). The FAAM-ADL (35.9%), FAAM–Sports (15.8%), and ATRS (20.4%) had substantial absolute ceiling effects. Conclusion: The PROMIS PF, FAAM-ADL, and FAAM–Sports all showed a moderate to high mutual correlation with the ATRS. Only the PROMIS PF avoided substantial floor and ceiling effects. The results suggest that the PROMIS PF CAT is a valid, reliable, and perhaps the most responsive tool to evaluate patient outcomes after treatment for an Achilles tendon rupture.

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“…Further analysis has shown that the repaired Achilles tendon is compliant, but that greater strain results in less effective energy storage, e.g., during hopping tasks [ 20 ]. Additionally, studies reported less plantarflexion and increased dorsiflexion during gait which was linked to tendon stiffness and elongation [ 1 , 9 , 21 ]. An altered neuromuscular activation pattern reflected by the augmented tibialis anterior muscle and soleus muscle co-contraction index has been shown to be present [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Neuromechanical activation of triceps surae muscle remains altered at 3.5 years following open surgical repair of acute Achilles tendon rupture

Mauch²,

Heitner³

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To assess whether the neuromuscular activation pattern following Achilles tendon rupture and repair may contributes to the observable functional deficits in this severe and increasingly frequent injury. Methods In this study, the neuromuscular activation using surface EMG of n = 52 patients was assessed during a battery of functional performance tasks to assess potential alterations of muscular activation and recruitment. We analyzed the injured leg vs. the contralateral healthy leg at a mean of 3.5 years following open surgical repair. The testing battery included isokinetic strength testing, bipedal and single-legged heel-rise testing as well as gait analysis. Results During isokinetic testing, we observed a higher activation integral for all triceps surae muscles of the injured side during active dorsiflexion, e.g., eccentric loading on the injured leg, while concentric plantarflexion showed no significant difference. Dynamic heel-rise testing showed a higher activation in concentric and eccentric loading for all posterior muscles on the injured side (not significant); while static heel-rise for 10 sec. revealed a significantly higher activation. Further analysis of frequency of fast Fourier-transformed EMG revealed a significantly higher median frequency in the injured leg. Gait analysis revealed a higher pre-activation of the tibialis anterior before ground contact, while medial and lateral gastrocnemius muscles of the injured leg showed a significantly higher activation during push-off phase. Conclusions The results of this study provide evidence on the neuromuscular changes 3.5 years following open surgical Achilles tendon repair. These complex neuromuscular changes are manifested to produce the maximum force output whilst protecting the previously injured tendon. The observed alterations may be related to an increased recruitment of type II muscle fibers which could make the muscles prone to fatigue. Level of evidence III.

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Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial

Cited by 39 publications

References 20 publications

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

Validation of PROMIS Physical Function for Evaluating Outcome After Acute Achilles Tendon Rupture

Neuromechanical activation of triceps surae muscle remains altered at 3.5 years following open surgical repair of acute Achilles tendon rupture

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