Relationship between recovery of calf-muscle biomechanical properties and gait pattern following surgery for achilles tendon rupture

Don, Romildo; Ranavolo, Alberto; Cacchio, Angelo; Serrao, Mariano; Costabile, Francesca; Iachelli, Massimo; Camerota, Filippo; Frascarelli, Massimo; Santilli, Valter

doi:10.1016/j.clinbiomech.2006.10.001

Cited by 92 publications

(115 citation statements)

References 33 publications

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“…Consistent with previous studies [5,12], there were no significant between-limb differences in GRF and basic spatiotemporal gait parameters during walking, suggesting a relatively symmetric gait pattern. The range of sagittal ankle motion, however, was significantly greater in the repaired than in the contralateral limb during walking.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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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“…Given these factors, the traditional rehabilitation model, which is based on non-weight bearing and immobilization, remains standard practice after AT repair. [3][4][5][6]8,14,16,21 However, the negative changes to plantar flexors 11,12 may be modified, as our findings suggested. Moreover, magnetic resonance imaging revealed that an organized scar forms over the AT during the 4 weeks after surgery in early rehabilitation models, 6 and no differences in rerupture rates between early and traditional models have been described in systematic reviews or meta-analyses.…”

Section: Discussionsupporting

confidence: 49%

“…Therefore, improving the restoration of physiologic plantar-flexion synergy is relevant in preventing new injuries that result from the pathologic actions of the musculoskeletal system 11,13 and is especially pertinent before starting exercises that place high levels of repetitive stress on the repaired AT. Considering this, clinicians must not only incorporate an early intervention plan of mobility or weight bearing after the AT repair but must also consider an appropriate neuromuscular plan, such as that proposed by Kearney et al, 3 Don et al, 11 and Finni et al 12 The final ATRS of the immediate group revealed fewer symptoms of autoperception with minimal clinically important differences compared with the traditional group after percutaneous AT repair.…”

Section: Discussionmentioning

confidence: 99%

“…The MVIC was determined using ; and (6) written informed consent. Exclusion criteria were (1) autoimmune disease; (2) previous tendinous injury of the lower limb; (3) history of trauma; (4) orthopaedic alterations of the lower limb; (5) history of chronic steroid therapy; (6) inability to receive postoperative treatment at our facility; (7) postoperative rehabilitation dropout 11 ; (8) lack of consistent attendance, defined as a greater than 50% absence rate from the total scheduled sessions; (9) thrombotic disease development 11 ; (10) cognitive alterations; or (11) any condition that would alter the assessed variables. The study was approved by the comité deética del Instituto Traumatológico.…”

Section: Participantsmentioning

confidence: 99%

“…1,8 Tendinous overload 6,9 and a nonuniform distribution of stress 10 promoted by neuromuscular imbalance 11 or pathologic muscular conditions 12 are mechanical factors that contribute to an AT rupture. 6,9,10 Rupture directly compromises motor tasks that require propulsion and takeoff actions, such as gait, running, and jumping, 11,13,14 and appropriate rehabilitation is required to improve the alterations, such as strength loss, that frequently develop after AT surgery. that begin 4 weeks after AT repair represent the traditional rehabilitation model, which is standard practice.…”

mentioning

confidence: 99%

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Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

Fuente

Lillo

Ramírez‐Campillo

et al. 2016

Journal of Athletic Training

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Context: Pathologic plantar flexion frequently occurs after operative repair of the Achilles tendon (AT) because of immobilization and non-weight bearing in the first weeks of traditional rehabilitation. Novel rehabilitation strategies that apply mobilization and weight bearing have been proposed, but their effects on medial gastrocnemius myotendinous junction displacement (MJD) and isometric plantar-flexion strength (PFS) are unknown.Objective: To compare the effects of 12 weeks of immediate versus traditional rehabilitation on MJD and PFS in patients with percutaneous AT repair and to compare AT rupture scores (ATRSs) during follow-up.Design: Controlled laboratory study. Setting: Human performance laboratory. Patients or Other Participants: A total of 26 amateur soccer players (age ¼ 42.3 6 9.7 years, body mass index ¼ 29.5 6 3.9 kg/m 2 ) with percutaneous AT repair. Intervention(s): Athletes were randomly divided into 2 groups: an immediate group, given physical therapy from day 1 to day 84, and a traditional group, given physical therapy from day 29 to day 84. We used repeated-measures analysis of variance to compare the data.Main Outcome Measure(s): We measured MJD and PFS at days 28 (fourth week), 56 (eighth week), and 84 (12th week) after AT repair.Results: After 12 weeks of rehabilitation, we observed a large clinically meaningful effect and statistical difference between groups. At day 28, the immediate group showed higher values for PFS (P ¼ .002), MJD (P ¼ .02), and ATRS (P ¼ .002) than the traditional group. At day 56, the immediate group presented higher values for MJD (P ¼ .02) and ATRS (P ¼ .009). At day 84, the immediate group registered more MJD (P ¼ .001).Conclusions: Compared with traditional rehabilitation, 12 weeks of immediate rehabilitation after percutaneous AT repair resulted in better MJD, PFS, and ATRS after 4 weeks; better MJD and ATRS after 8 weeks; and better MJD after 12 weeks.

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Biomechanical properties of the plantar flexor muscle–tendon complex 6 months post‐rupture of the achilles tendon

McNair

Nordez

Olds

et al. 2013

Journal Orthopaedic Research

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ABSTRACT:We compared the effects of a non-weight bearing protocol (NWB) and a weight bearing (WB) protocol on energy stored, stiffness, and shock absorption in the plantar flexor muscle-tendon unit of patients managed non-operatively following an Achilles tendon rupture. Thirty-eight subjects were randomized to a WB cast fitted with a Bohler iron or a traditional non-weight-bearing cast. At a 6-month follow-up, a biomechanical assessment utilizing an isokinetic dynamometer allowed measurement of peak passive torque, energy stored, shock absorption, and stiffness. The WB group had greater peak passive torque ($20%). Irrespective of group, peak passive torque in unaffected legs was greater ($26%) than affected legs. Across the groups, energy stored in the NWB group was 74% of the WB group. The energy stored in affected legs was 80% of that in unaffected legs. Shock absorption was not significantly different across legs or groups. Irrespective of group, affected legs had significantly less stiffness (20-40%). While the augmentation of plaster with a Bohler iron to allow increased weight bearing had positive effects, deficits in affected compared to unaffected legs irrespective of group were notable, and should be addressed prior to participation in vigorous physical activities. ß

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Relationship between recovery of calf-muscle biomechanical properties and gait pattern following surgery for achilles tendon rupture

Cited by 92 publications

References 33 publications

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

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

Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

Biomechanical properties of the plantar flexor muscle–tendon complex 6 months post‐rupture of the achilles tendon

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