Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury

Brorsson, Annelie; Willy, Richard W.; Tranberg, Roy; Silbernagel, Karin Grävare

doi:10.1177/0363546517717698

Cited by 57 publications

(118 citation statements)

References 43 publications

(55 reference statements)

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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%

“…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 .…”

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: Introductionmentioning

confidence: 99%

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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“…In order to achieve similar jump height, the knee performs greater peak power during the takeoff phase as well as relative work over both takeoff and landing phases as suggested by our findings. Prior work by Brorsson et al, found that tendon elongation and calf endurance related, respectively, to ankle kinematics and kinetics during jumping. While this study was not designed to allow for correlational analysis, it may be that the tendon elongation observed in this group of individuals underlies changes in biomechanics.…”

Section: Discussionmentioning

confidence: 94%

“…In fact, studies have identified focal deficits in plantar flexor strength at 10 or more years following rupture . Furthermore, recent studies have identified altered ankle kinetics and kinematics as well as a shift of lower extremity peak power generation during running and jumping tasks from the ankle to the knee in individuals an average of 6 years following rupture …”

mentioning

confidence: 99%

“…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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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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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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Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury

Cited by 57 publications

References 43 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

Lower extremity work along with triceps surae structure and activation is altered with jumping after Achilles tendon repair

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

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