Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play

Zellers, Jennifer A.; Carmont, Michael R.; Silbernagel, Karin Grävare

doi:10.1136/bjsports-2016-096106

Cited by 118 publications

(111 citation statements)

References 150 publications

(73 reference statements)

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…2 Despite these improvements in long-term tendon integrity, one-in-five patients do not return to their activities they enjoyed prior to the injury. 3 Short-term functional deficits are predictive of longterm plantarflexor strength and endurance deficits, 1 which persist at least seven years following the initial injury. 4 Despite these documented functional deficits, little is known regarding how muscle-tendon structure dictates function in this patient population.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…This welldocumented increase in the prevalence of acute Achilles tendon ruptures (15,19,25) is mostly likely explained by the recent rise in sports participation amongst aging adults (15). While advances in rehabilitation protocols have improved outcomes in patients treated either operatively or non-operatively (34), approximately one out of five patients without other complications are unable to return to their previous levels of athletic participation (36).…”

Section: Introductionmentioning

confidence: 99%

Gastrocnemius fascicles are shorter and more pennate throughout the first month following acute Achilles tendon rupture

Hullfish

O’Connor

Baxter

2018

Preprint

View full text Add to dashboard Cite

1The purpose of this study was to characterize the short-term effects of Achilles tendon 2 ruptures on medial gastrocnemius. We hypothesized that the fascicles of the medial 3 gastrocnemius muscle of the injured Achilles tendon would be shorter and more pennate 4 immediately following the injury and would persist throughout 4 weeks post-injury. B-mode 5 longitudinal ultrasound images of the medial gastrocnemius were acquired in 10 adults who 6 suffered acute Achilles tendon ruptures and were treated non-operatively. Ultrasound images 7 were acquired during the initial clinical visit following injury as well as two and four weeks 8 following this initial clinical visit. Resting muscle structure was characterized by measuring 9 fascicle length, pennation angle, muscle thickness, and muscle echo intensity in both the injured 1 0 and contralateral (control) limbs. Fascicle length was 15% shorter (P < 0.001) and pennation 1 1 angle was 21% greater (P < 0.001) in the injured muscle compared to the uninjured (control) 1 2 muscle at the presentation of injury (week 0). These differences in fascicle length and pennation 1 3 angle persisted throughout the 4 weeks after the injury (P < 0.008). Muscle thickness changes 1 4were not detected at any of the post-injury visits (difference < 4%, P > 0.04). Echo intensity of 1 5 the injured limb was 8% lower at the presentation of the injury and 11% lower (P = 0.008) than 1 6 the contralateral muscle at 2 weeks following injury (P < 0.001) but returned to within 1% by 4 1 7 weeks (P = 0.393). Our results suggest that Achilles tendon ruptures elicit rapid changes in the

show abstract

“… 20 , 40 The injury produces long-term limitations, 19 , 20 , 22 , 29 and many patients fail to return to sports activities at the same level of performance as that before injury. 43 …”

mentioning

confidence: 99%

Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

Carmont

Zellers

Brorsson

et al. 2017

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background:The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications.Purpose:To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures.Study Design:Cohort study; Level of evidence, 3.Methods:Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks.Results:There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively).Conclusion:Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.

show abstract

Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play

Cited by 118 publications

References 150 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

Gastrocnemius fascicles are shorter and more pennate throughout the first month following acute Achilles tendon rupture

Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

Contact Info

Product

Resources

About