Early Neuromechanical Outcomes of the Triceps Surae Muscle-Tendon After an Achilles' Tendon Repair

Background: Specific guidelines for therapeutic exercises following an Achilles tendon repair are lacking. Hypothesis: A hierarchical progression of triceps surae exercises can be determined on the basis of electromyographic (EMG) activity. Study Design: Randomized laboratory trial. Methods: Bipolar surface electrodes were applied over the medial and lateral heads of the gastrocnemius as well as the soleus on 20 healthy lower extremities (10 participants, 27 ± 5 years old). Muscle activity was recorded during 8 therapeutic exercises commonly used following an Achilles repair. Maximal voluntary isometric contractions (MVICs) were also performed on an isokinetic device. The effect of exercise on EMG activity (% MVIC) was assessed using repeated measures analysis of variance with Bonferroni corrections for planned pairwise comparisons. Results: Seated toe raises (11% MVIC) had the least amount of activity compared with all other exercises ( P < 0.01), followed by single-leg balance on wobble board (25% MVIC), prone ankle pumps (38% MVIC), supine plantarflexion with red elastic resistance (45% MVIC), normal gait (47% MVIC), lateral step-ups (60% MVIC), single-leg heel raises (112% MVIC), and single-leg jumping (129% MVIC). Conclusion: There is an increasing progression of EMG activity for exercises that target the triceps surae muscle complex during common exercises prescribed in an Achilles tendon rehabilitation program. Seated toe raises offer relatively low EMG activity and can be utilized as an early rehabilitative exercise. In contrast, the single-leg heel raise and single-leg jumping should be utilized only during later-stage rehabilitation. Clinical Relevance: EMG activity in the triceps surae is variable with common rehab exercises.

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Functional Ankle Range of Motion but Not Peak Achilles Tendon Force Diminished With Heel-Rise and Jumping Tasks After Achilles Tendon Repair

The American Journal of Sports Medicine ◽

10.1177/03635465211019436 ◽

2021 ◽

pp. 036354652110194

Author(s):

Jennifer A. Zellers ◽

Josh R. Baxter ◽

Karin Grävare Silbernagel

Keyword(s):

Achilles Tendon ◽

Range Of Motion ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Mean Difference ◽

Triceps Surae ◽

Plantar Flexor ◽

Achilles Tendon Repair ◽

Ankle Function

Background: Deficits in sporting performance after Achilles tendon repair may be due to changes in musculotendinous unit structure, including tendon elongation and muscle fascicle shortening. Purpose/Hypothesis: The purpose was to discern whether Achilles tendon rupture reduces triceps surae muscle force generation, alters functional ankle range of motion, or both during sports-related tasks. We hypothesized that individuals who have undergone Achilles tendon repair lack the functional ankle range of motion needed to complete sports-related tasks. Study Design: Descriptive laboratory study. Methods: The study included individuals 1 to 3 years after treatment of Achilles tendon rupture with open repair. Participants (n = 11) completed a heel-rise task and 3 jumping tasks. Lower extremity biomechanics were analyzed using motion capture. Between-limb differences were tested using paired t test. Results: Pelvic vertical displacement was reduced during the heel-rise (mean difference, −12.8%; P = .026) but not during the jumping task ( P > .1). In the concentric phase of all tasks, peak ankle plantarflexion angle (range of mean difference, −19.2% to −48.8%; P < .05) and total plantar flexor work (defined as the area under the plantar flexor torque – ankle angle curve) (range of mean difference, −9.5% to −25.7%; P < .05) were lower on the repaired side relative to the uninjured side. No significant differences were seen in peak Achilles tendon load or impulse with any of the tasks. There were no differences in plantar flexor work or Achilles tendon load parameters during eccentric phases. Conclusion: Impaired task performance or increased demands on proximal joints were observed on the repaired side in tasks isolating ankle function. Tasks that did not isolate ankle function appeared to be well recovered, although functional ankle range of motion was reduced with rupture. Reduced plantar flexor muscle-tendon unit work supports previous reports that an elongated tendon and shorter muscle fascicles caused by Achilles tendon rupture constrain functional capacity. Achilles tendon peak load and impulse were not decreased, suggesting that reduced and shifted functional ankle range of motion (favoring dorsiflexion) underlies performance deficits. Clinical Relevance: These findings point to the need to reduce tendon elongation and restore muscle length of the triceps surae after Achilles tendon rupture in order to address musculature that is short but not necessarily weak for improved performance with sports-related activities.

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Pulsed Magnetic Field Therapy Increases Tensile Strength in a Rat Achilles' Tendon Repair Model

Yearbook of Plastic and Aesthetic Surgery ◽

10.1016/s1535-1513(08)70693-3 ◽

2008 ◽

Vol 2008 ◽

pp. 229

Author(s):

W.L. Garner

Keyword(s):

Magnetic Field ◽

Tensile Strength ◽

Achilles Tendon ◽

Tendon Repair ◽

Pulsed Magnetic Field ◽

Achilles Tendon Repair ◽

Magnetic Field Therapy ◽

Field Therapy

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Achillon Mini-Open Achilles Tendon Repair: Early Outcomes and Return to Duty Results in U.S. Military Service Members

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2013.0023 ◽

2013 ◽

Vol 22 (01) ◽

pp. 23-29 ◽

Cited By ~ 8

Author(s):

Justin D. Orr ◽

Brendan McCriskin ◽

Jason R. Dutton

Keyword(s):

Achilles Tendon ◽

Military Service ◽

Tendon Repair ◽

Service Members ◽

Achilles Tendon Repair ◽

Military Service Members ◽

Return To Duty ◽

Mini Open

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30 Achilles Tendon Repair

Outlines in Orthopaedic Surgery ◽

10.1055/b-0040-174153 ◽

2020 ◽

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Achilles Tendon Repair

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Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00161 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0016

Author(s):

Daniel Bohl ◽

Eric Barnard ◽

Kamran Movassaghi ◽

Kamran Hamid ◽

Adam Schiff

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Suture Material ◽

Tendon Repair ◽

Wound Complications ◽

Transverse Incision ◽

Longitudinal Incision ◽

Achilles Tendon Repair ◽

Deep Suture ◽

No Tourniquet

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.

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The Effect of Obesity on Achilles Rupture Repair

Foot & Ankle Specialist ◽

10.1177/1938640018816376 ◽

2018 ◽

Vol 12 (6) ◽

pp. 503-512 ◽

Cited By ~ 1

Author(s):

Jeffery S. Hillam ◽

Neil Mohile ◽

Niall Smyth ◽

Jonathan Kaplan ◽

Amiethab Aiyer

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Wound Dehiscence ◽

Comorbid Conditions ◽

Improvement Program ◽

Acs Nsqip ◽

Achilles Tendon Repair ◽

Increased Risk ◽

American College Of Surgeons ◽

Tendon Ruptures

Introduction. Obesity is an increasingly common comorbidity that may negatively affect outcomes following orthopaedic surgery. It is valuable to determine whether obese patients are vulnerable for postoperative complications. The purpose of this study was to analyze data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods. Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the ACS NSQIP. The patients were divided into 2 cohorts (obese and nonobese), then perioperative and postoperative factors were evaluated for association with obesity. Results. A total of 2128 patients were identified, of whom 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 versus 56.1 minutes. The only postoperative complication associated with obesity was wound dehiscence. Logistic regression adjusted for comorbid conditions demonstrated that obesity was not associated with an increased risk of wound dehiscence. Conclusion. A large segment of the patient population undergoing Achilles tendon repair is obese. Obesity was found to have an increased association with wound dehiscence, likely related to comorbid conditions, following Achilles tendon repair. Obesity was not significantly associated with any other complication. Levels of Evidence: III, Retrospective Cohort Study

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