Development and reliability of the Achilles Tendon Length Measure and comparison with the Achilles Tendon Resting Angle on patients with an Achilles tendon rupture

Category: Ankle, Sports Introduction/Purpose: Tendon elongation is associated with poor functional outcome in individuals after Achilles tendon rupture. While imaging modalities are reliable to measure Achilles tendon length, alternative time- and cost-effective measures are of interest. The resting angle of the ankle in prone both with knee extended1 and knee flexed2 have been used in the literature as surrogates for measuring Achilles elongation, however, their relationship to tendon length is not well-established. The purpose of this study is to validate the ankle resting angle as a measure of tendon elongation and examine the relationship of ankle resting angle to tendon elongation and calf strength. Methods: Individuals following unilateral Achilles tendon rupture, treated surgically, were included in this cross-sectional study. Individuals were excluded if they had deep wound infection or lumbar radiculopathy affecting the ankle plantar flexors. Ankle resting angle with knee extended and knee flexed to 90 degrees was measured using a digital inclinometer positioned on the lateral, plantar surface of the foot. Relative resting angle was calculated by subtracting the uninjured from the injured side. Tendon length to gastrocnemius was measured using B mode, extended field of view ultrasound imaging3 (tendon elongation = ruptured- uninjured). Calf strength was measured using the heel-rise test4. Limb symmetry indexes (LSI) were calculated (ruptured/uninjured sidex100) for total work performed on the heel-rise test. Results: Twenty-five individuals, a mean(SD) age of 44.2(13.6) years and mean(SD) of 22.5(39.1) months post-rupture, were included in this study. Mean(SD) relative resting angle with knee flexed was -5.4(6.4)° and mean (SD) relative resting angle with knee extended was -6.7(8.8)°. Mean(SD) tendon elongation was 1.56(1.20)cm. Mean(SD) heel-rise test work LSI was 45.8(23.8)%. Ankle resting angle with knee flexed related to elongation (r = -0.452, p = 0.027) and heel-rise test work LSI (r = 0.591, p=0.006). Ankle resting angle with knee extended related to elongation (r=-0.528, p=0.008) (Figure 1) but not heel-rise test work LSI. Conclusion: The results of this study suggest that ankle resting angle with knee extended and flexed are related to tendon elongation, however, calf strength also has a relationship to resting angle with knee flexed. This suggests that the ability of the calf to put passive tension on the foot is also a component of resting angle. The relationship between tendon elongation and resting angle with knee flexed may have been limited by methodological concerns, as tendon length was measured with the participant positioned with knees extended.

Download Full-text

Repair of Chronic Complete Traumatic Rupture of the Common Calcaneal Tendon in a Dog, Using a Fascia Lata Graft

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632639 ◽

2000 ◽

Vol 13 (02) ◽

pp. 104-108 ◽

Cited By ~ 16

Author(s):

J. Shani ◽

R. Shahar

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Fascia Lata ◽

Traumatic Rupture ◽

Free Graft ◽

Calcaneal Tendon ◽

Tendon Length ◽

The Common ◽

Successful Repair

SummaryA 3-month-old male Cocker Spaniel was presented with the complaint of chronic right hind leg lameness. The owner described superficial trauma at the area of the hock, which was noticed immediately after delivery. History, habitus, physical examination, and radiography suggested rupture of the common calcaneal tendon. This report describes the successful repair of complete rupture of the common calcaneal tendon, with loss of tendon length, using a fascia lata free graft.The following case report describes the successful repair of a chronic complete traumatic rupture of all components of the Achilles tendon with loss of tendon length, in a 3-month-old puppy, using a tensor fascia lata free graft. Due to the young age of the animal no internal fixation was used to protect the graft, and external coaptation was used instead. Achilles tendon rupture is a relatively common injury in humans and many methods of repair are reported for acute and chronic ruptures. The medical and veterinary literature is reviewed with regard to the pathogenesis and treatment of Achilles tendon rupture.

Download Full-text

Gait Function and Postural Control 4.5 Years After Nonoperative Dynamic Treatment of Acute Achilles Tendon Ruptures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119854324 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985432 ◽

Cited By ~ 4

Author(s):

Merete B. Speedtsberg ◽

Rasmus Kastoft ◽

Kristoffer W. Barfod ◽

Jeanette Ø. Penny ◽

Jesper Bencke

Keyword(s):

Achilles Tendon ◽

Center Of Pressure ◽

Dynamic Stiffness ◽

Plantar Flexion ◽

Achilles Tendon Rupture ◽

Case Series ◽

Tendon Length ◽

Balance Task ◽

Achilles Tendon Length

Background: An Achilles tendon rupture (ATR) is known to cause persistent biomechanical deficits such as decreased muscle strength in end-range plantar flexion and reduced tendon stiffness. Purpose/Hypothesis: This study aimed to examine whether sustained asymmetries were present in dynamic stiffness and kinematic and kinetic variables in gait and single-leg balance at 4.5-year follow-up in conservatively treated patients recovering from an ATR. We hypothesized that patients who had recovered from ATRs exhibit a midterm increase in peak ankle dorsiflexion, a decrease in concentric work, and decreased dynamic stiffness during the stance phase of gait, along with increased single-leg standing sway in the injured leg compared with the uninjured leg. Study Design: Case series; Level of evidence, 4. Methods: This study was a cross-sectional medium-term follow-up of conservatively treated patients recovering from ATRs. A total of 34 patients who underwent nonoperative treatment were included for testing 4.5 years after a rupture. The Achilles tendon length was measured using ultrasound. Standard instrumented 3-dimensional (3D) gait analysis and single-leg standing balance were performed using 3D motion capture. Kinematic and kinetic ankle parameters were calculated during gait, and quasi-stiffness was calculated as the moment change per the change in the degree of dorsiflexion during the second (ankle) rocker of the gait cycle. Center of pressure displacement (sway length), along with rambling and trembling, was calculated for the single-leg balance task. Results: Peak dorsiflexion in stance was 13.4% larger in the injured leg than the uninjured leg (16.9° ± 3.1° vs 14.9° ± 0.4°, respectively; P ≤ .001). Peak dorsiflexion was not associated with the normalized Achilles tendon length (B = 0.052; P = .775). Total positive work in the plantar flexors was 23.9% greater in the uninjured leg than the injured leg (4.71 ± 1.60 vs 3.80 ± 0.79 J/kg, respectively; P = .001). Quasi-stiffness was greater in the uninjured leg than the injured leg during the initial (0.053 ± 0.022 vs 0.046 ± 0.020 N·m/kg/deg, respectively; P = .009) and late (0.162 ± 0.110 vs 0.139 ± 0.041 N·m/kg/deg, respectively; P = .005) phases of eccentric loading. No difference was found in sway length during single-leg stance between the injured and uninjured legs (1.45 ± 0.4 vs 1.44 ± 0.4 m, respectively; P = .955). Conclusion: Patients treated conservatively have a small increase in peak dorsiflexion, decreased total concentric plantar flexor power, and decreased quasi-stiffness in initial and end-range dorsiflexion in the injured leg. These deviations could not be directly associated with the measured tendon elongation. Registration: NCT02760784 ( ClinicalTrials.gov ).

Download Full-text

21 Validation of achilles tendon length measure and achilles tendon resting angle in relation to copenhagen achilles length measure

10.1136/bjsports-2019-scandinavianabs.21 ◽

2019 ◽

Author(s):

Maria Swennergren Hansen ◽

Morten Tange Kristensen ◽

Per Hölmich ◽

Kristoffer Weisskrichner Barfod

Keyword(s):

Achilles Tendon ◽

Tendon Length ◽

Length Measure ◽

Achilles Tendon Length

Download Full-text

Achilles Tendon Resting Angle Relates to Tendon Length and Function

Foot & Ankle International ◽

10.1177/1071100717742372 ◽

2017 ◽

Vol 39 (3) ◽

pp. 343-348 ◽

Cited By ~ 21

Author(s):

Jennifer A. Zellers ◽

Michael R. Carmont ◽

Karin Grävare Silbernagel

Keyword(s):

Mechanical Properties ◽

Achilles Tendon ◽

Test Performance ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Shear Wave Elastography ◽

Level Of Evidence ◽

Tendon Length ◽

Tendon Elongation ◽

The Relationship

Background: Following Achilles tendon rupture, tendon elongation leads to long term deficits in calf function. A surrogate measure of Achilles tendon length, Achilles tendon resting angle (ATRA), has been described but has not been validated against length measured using ultrasound. Therefore, the purpose of this study was to validate the ATRA against ultrasound. Secondarily, this study aimed to identify the relationship of other factors (tendon mechanical properties, heel-rise test performance) to the ATRA. Methods: Individuals following unilateral Achilles tendon rupture were included. ATRA was measured in knee flexed and extended positions. Tendon elongation was measured using extended field of view ultrasound imaging. Continuous shear wave elastography quantified tendon mechanical properties. The relationship between variables was tested using Spearman’s ρ. Subgroup analysis was used to compare subjects with less then or greater than 1 year following rupture. A total of 42 participants (with a mean of 18.2 months following rupture [SD = 35.9]) were included. Results: Tendon elongation related with relative ATRA with knee flexed (ρ = .491, P = .001) and knee extended (ρ = 0.501, P = .001) positions. In individuals greater than 1 year following rupture, relative ATRA with the knee flexed related to shear modulus (ρ = .800, P = .01) and total work on the heel-rise test (ρ = –.782, P = .008) relative to the uninjured side. Conclusion: Relative ATRA in both knee flexed and knee extended positions has a moderate relationship to tendon elongation within the first year following rupture. After 1 year, the relative ATRA with knee flexed may be a better indicator of tendon elongation and also related to tendon mechanical properties and heel-rise test performance. Level of Evidence: Level III, case-control study.

Download Full-text