Increased unilateral tendon stiffness and its effect on gait 2–6 years after <scp>A</scp>chilles tendon rupture

Agres, Alison N.; Duda, Georg N.; Gehlen, Tobias; Arampatzis, Adamantios; Taylor, William R.; Manegold, Sebastian

doi:10.1111/sms.12456

Cited by 53 publications

(85 citation statements)

References 41 publications

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“…Other factors such as plantarflexor moment arm, 29 muscle composition, 41 and foot length 42 affect plantarflexor function but were excluded in this study to focus on MTU parameters that are documented to change in response to Achilles tendon ruptures. 5,8,27 The plantarflexors were represented by a single gastrocnemius MTU and a soleus MTU (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

Plantarflexor fiber length and tendon slack length are the strongest determinates of simulated single-leg heel raise function

Baxter

Farber

Hast

2018

Preprint

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Achilles tendon ruptures lead to reduced ankle function and often limits recreational activity. Single-leg heel raises are often used clinically to characterize patient function. However, it is unclear how the structure of the Achilles tendon and plantarflexor muscles affects single-leg heel raise function. Therefore, the purpose of this study was to develop a musculoskeletal model in order to simulate the effects of muscle-tendon unit (MTU) parameters on peak plantarflexion during this clinically-relevant task. The ankle joint was plantarflexed by two MTUs that represented the soleus and gastrocnemius muscles. The optimal fiber length, maximal muscle force, muscle pennation, tendon stiffness, and resting ankle anglea surrogate measure of tendon slack length were iteratively adjusted to test the combined effects of each of these MTU parameters. Singleleg heel raises were simulated by maximally exciting the two plantarflexor MTUs for each model configuration (N = 161,051 simulations). Optimal muscle fiber and tendon slack lengths had the greatest effect on peak plantarflexion during simulated single-leg heel raises. Simulations that were unable to produce at least 30 degrees of plantarflexion had muscle fibers that were shorter than healthy muscle and longer tendon slack lengths. These findings highlight the importance of preserving muscle fascicle and tendon length following Achilles tendon injuries.

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Section: Discussionmentioning

confidence: 99%

Plantarflexor fiber length and tendon slack length are the strongest determinates of simulated single-leg heel raise function

Baxter

Farber

Hast

2018

Preprint

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“…It is important to note, however, that observed differences in both maximum dorsiflexion and plantarflexion in this study were close to the measurement resolution of the electrogoniometer and were relatively small in absolute terms (1° and 2°, respectively). Although the clinical relevance of such small differences in ankle motion may be unclear [1], the differences represented a large effect according to Cohen's convention, suggesting the effect was consistent across patients. This study has a number of potential limitations.…”

Section: Discussionmentioning

confidence: 99%

Lower material stiffness in rupture-repaired Achilles tendon during walking: transmission-mode ultrasound for post-surgical tendon evaluation

Wulf

Shanker

Schuetz

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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potential between-limb differences in TSOU, GRF, ankle motion, and spatiotemporal gait parameters. Results TSOU was significantly lower (≈175 m/s) in the repaired than in the contralateral AT over the entire gait cycle (P < 0.05). Sagittal ankle motion was significantly greater (≈3°) in the repaired than in the contralateral limb (P = 0.036). There were no significant differences in GRF or spatiotemporal parameters between limbs. Conclusions Repaired AT was characterised by a lower TSOU, reflecting a lower material stiffness in the repaired tendon than in the contralateral tendon. A lower material stiffness may underpin greater ankle joint motion of the repaired limb during walking and long-term deficits in the muscle-tendon unit reported with AT repair. Treatment and rehabilitation approaches that focus on increasing the material stiffness of the repaired AT may be clinically beneficial. Transmission-mode ultrasound would seem useful for quantifying tendon properties post AT rupture repair and may have the potential to individually guide AbstractPurpose This cross-sectional study used transmissionmode ultrasound to evaluate dynamic tendon properties during walking in surgically repaired and contralateral Achilles tendon (AT), with a median (range) post-operative period of 22 (4-58)

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confidence: 99%

“…Lengthening of the Achilles tendon, which typically occurs within the first 12 weeks following injury, has been found to relate to poor performance on isolated calf strength testing, [6][7][8] altered biomechanics, 6 and poor patient outcomes. 9,10 Also at the tendon level, tendon mechanical properties have been found be altered following rupture [11][12][13][14] and to relate to performance on strength testing 14,15 and walking gait. 12 From a muscular standpoint, lower muscle volumes in the triceps surae [16][17][18] and fatty infiltration of the soleus muscle have been found to relate to decreases in plantar flexor strength.…”

mentioning

confidence: 99%

“…9,10 Also at the tendon level, tendon mechanical properties have been found be altered following rupture [11][12][13][14] and to relate to performance on strength testing 14,15 and walking gait. 12 From a muscular standpoint, lower muscle volumes in the triceps surae [16][17][18] and fatty infiltration of the soleus muscle have been found to relate to decreases in plantar flexor strength. 16 It also seems that the triceps surae musculature is consistently more metabolically active following Achilles tendon rupture.…”

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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Increased unilateral tendon stiffness and its effect on gait 2–6 years after Achilles tendon rupture

Cited by 53 publications

References 41 publications

Plantarflexor fiber length and tendon slack length are the strongest determinates of simulated single-leg heel raise function

Plantarflexor fiber length and tendon slack length are the strongest determinates of simulated single-leg heel raise function

Lower material stiffness in rupture-repaired Achilles tendon during walking: transmission-mode ultrasound for post-surgical tendon evaluation

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

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