Surgical treatment of chronic Achilles tendon rupture results in improved gait biomechanics

Abstract

Background Chronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not been quantified in the literature. Methods A total of 23 patients with a Chronic Achilles tendon rupture (mean age 61 ± 15 years) underwent three-dimensional gait analysis according to a standardized protocol using an optical tracking system. Data of spatiotemporal, kinematic and kinetic variables were collected preoperatively and one year postoperatively. In addition, the postoperative gait biomechanics were compared with the gait biomechanics of a control group consisting of 70 healthy individuals (mean age 49 ± 20 years). The prospectively collected data were analyzed by an independent t test. Results Postoperatively, increments were found in gait speed (mean difference − 0.12 m/s), stride length (− 0.12 m), peak ankle moment (− 0.64 Nm/kg), peak ankle power (− 1.38 W/kg), peak knee power (− 0.36 m) and reduced step width (0.01 m), compared with preoperative gait biomechanics (p < 0.014). Compared with the control group, patients with a Chronic Achilles tendon rupture exhibited slower postoperative gait speed (mean difference 0.24 m/s), wider step width (− 0.02 m), shorter stride length (0.16 m), longer relative stance phase (− 2.15%), lower peak knee flexion (17.03 degrees), greater peak knee extension (2.58 degrees), lower peak ankle moment (0.35 Nm/kg), peak ankle power (1.22 W/kg) and peak knee power (1.62 W/kg), (p < 0.010). Conclusion Surgical intervention and postoperative rehabilitation can be an effective treatment for alterations in gait after a Chronic rupture of the Achilles tendon. However, at one year postoperatively, patients still exhibit impairments in spatiotemporal variables and knee and ankle power compared with healthy controls.

Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM)

“…In reference to the results obtained by other authors, who assessed the behavior of the biomechanical gait parameters over a period of 6 to 12 months, as well as in a longer period of time after AT surgery [ 12 , 13 , 14 , 21 , 27 , 28 , 29 ], our study showed a significant improvement in the twentieth week after surgical suturing of Achilles tendon using an open method (SSATOM) in most of the analyzed values of 3D gait parameters. However, the authors of the current study did not achieve the restoration of all gait parameters in patients after SSATOM, which would be similar to the non-operated side and the results of the control group.…”

“…The literature analysis indicates that some of the authors presented a biomechanical assessment of gait in patients treated conservatively [ 22 , 26 , 40 , 41 , 42 ] and surgically [ 21 , 27 , 43 ] after AT rupture. Moreover, studies indicate that the authors used various methods and surgical techniques [ 44 , 45 , 46 ].…”

“…Moreover, we did not reach a valid answer to the following question: Is it possible to better improve the values of analyzed 3D gait parameters in Group I patients by conducting an average of three visits per week, in accordance with the planned SVPh protocol, and thus with a higher total number of SVPh visits in the 20 weeks after SSATOM? On the other hand, other studies have shown that only time after treatment has a full influence on the return of symmetrical and normative 3D gait parameters of patients after Achilles tendon rupture [ 12 , 13 , 14 , 21 , 27 , 28 , 29 ].…”

“…Finally, the authors found few gait disturbances during walking compared with 6 months after surgery [ 21 ]. Nordenholm et al (2022) showed that performing a surgery after the AT rupture and postoperative rehabilitation may be an effective way to improve the values of the biomechanical parameters of walking after the incident [ 27 ]. However, even 12 months after surgery, patients showed significantly lower values of gait speed, step width, shorter stride length, longer relative stance phase, and power disturbances during walking compared with the control group [ 27 ].…”

“…Nordenholm et al (2022) showed that performing a surgery after the AT rupture and postoperative rehabilitation may be an effective way to improve the values of the biomechanical parameters of walking after the incident [ 27 ]. However, even 12 months after surgery, patients showed significantly lower values of gait speed, step width, shorter stride length, longer relative stance phase, and power disturbances during walking compared with the control group [ 27 ]. Chan et al (2011) conducted an analysis of gait in two groups of patients after the surgical suturing of the AT, using the open and the mini-open methods.…”