scholarly journals Gastrocnemius muscle remodeling explains functional deficits three months following Achilles tendon rupture

2019 ◽  
Author(s):  
Todd J. Hullfish ◽  
Kathryn M. O’Connor ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Gastrocnemius Muscle ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Peak Torque ◽  
Pennation Angle ◽  
Medial Gastrocnemius ◽  
Fascicle Length ◽  
Functional Deficits ◽  
Muscle Remodeling

ABSTRACTPlantarflexor functional deficits are associated with poor outcomes in patients following Achilles tendon rupture. In this longitudinal study, we analyzed the fascicle length and pennation angle of the medial gastrocnemius muscle and the length of the Achilles tendon using ultrasound imaging. To determine the relationship between muscle remodeling and functional deficits measured at 3 months after injury, we correlated the reduction in fascicle length and increase in pennation angle with peak torque measured during isometric plantarflexor contractions and peak power measured during isokinetic plantarflexor contractions. We found that the medial gastrocnemius underwent an immediate change in structure, characterized by decreased length and increased pennation of the muscle fascicles. This decrease in fascicle length was coupled with an increase in tendon length. These changes in muscle-tendon structure persisted throughout the first three months following rupture. Deficits in peak plantarflexor power were moderately correlated with decreased fascicle length at 120 degrees per second (R2= 0.424,P= 0.057) and strongly correlated with decreased fascicle length at 210 degrees per second (R2= 0.737,P= 0.003). However, increases in pennation angle did not explain functional deficits. These findings suggest that muscle-tendon structure is detrimentally affected following Achilles tendon rupture. Plantarflexor power deficits are positively correlated with the magnitude of reductions in fascicle length. Preserving muscle structure following Achilles tendon rupture should be a clinical priority to maintain patient function.

scholarly journals Medial gastrocnemius muscle remodeling correlates with reduced plantarflexor kinetics 14 weeks following Achilles tendon rupture

2019 ◽  
Vol 127 (4) ◽  
pp. 1005-1011 ◽  
Author(s):  
Todd J. Hullfish ◽  
Kathryn M. O’Connor ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Gastrocnemius Muscle ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Peak Torque ◽  
Pennation Angle ◽  
Medial Gastrocnemius ◽  
Fascicle Length ◽  
Muscle Remodeling ◽  
Medial Gastrocnemius Muscle

Deficits in plantarflexor kinetics are associated with poor outcomes in patients following Achilles tendon rupture. In this longitudinal study, we analyzed the fascicle length and pennation angle of the medial gastrocnemius muscle and the length of the Achilles tendon using ultrasound imaging. To determine the relationship between muscle remodeling and deficits in plantarflexor kinetics measured at 14 wk after injury, we correlated the reduction in fascicle length and increase in pennation angle with peak torque measured during isometric and isokinetic plantarflexor contractions. We found that the medial gastrocnemius underwent an immediate change in structure, characterized by decreased length and increased pennation of the muscle fascicles. This decrease in fascicle length was coupled with an increase in tendon length. These changes in muscle-tendon structure persisted throughout the first 14 wk following rupture. Deficits in peak plantarflexor torque were moderately correlated with decreased fascicle length at 120 degrees per second ( R2 = 0.424, P = 0.057) and strongly correlated with decreased fascicle length at 210 degrees per second ( R2 = 0.737, P = 0.003). However, increases in pennation angle did not explain functional deficits. These findings suggest that muscle-tendon structure is detrimentally affected following Achilles tendon rupture. Plantarflexor power deficits are positively correlated with the magnitude of reductions in fascicle length. Preserving muscle structure following Achilles tendon rupture should be a clinical priority to maintain plantarflexor kinetics. NEW & NOTEWORTHY In our study, we found that when the Achilles tendon ruptures due to excessive biomechanical loading, the neighboring skeletal muscle undergoes rapid changes in its configuration. The magnitude of this muscle remodeling explains the amount of ankle power loss demonstrated by these patients once their Achilles tendons are fully healed. These findings highlight the interconnected relationship between muscle and tendon. Isolated injuries to the tendon stimulate detrimental changes to the muscle, thereby limiting joint-level function.

scholarly journals Functional Deficits are Explained by Plantarflexor Remodeling Following Achilles Tendon Rupture Repair: Preliminary Findings

2018 ◽  
Author(s):  
Josh R. Baxter ◽  
Todd J. Hullfish ◽  
Wen Chao
Keyword(s):  
Skeletal Muscle ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Medial Gastrocnemius ◽  
Fascicle Length ◽  
Functional Deficits ◽  
Limited Function ◽  
Poor Outcomes ◽  
Muscle Remodeling

AbstractAchilles tendon ruptures are painful injuries that often lead to long-term functional deficits. Despite the prevalence of these injuries, the mechanism responsible for limited function has not yet been established. Therefore, the purpose of this study was to present preliminary findings that support a hypothesis that skeletal muscle remodeling is the driving factor of poor outcomes in some patients. Biomechanical and ultrasonography assessments were performed on a patient that presented with poor functional outcomes 2.5 years after a surgically-repaired acute Achilles tendon rupture. Single-leg heel raise function was decreased by 70% in the affected limb while walking mechanics showed no deficits. Ultrasonography revealed that the affected limb had shorter, more pennated, and less thick medial gastrocnemius muscles compared to the unaffected limb. A simple computational model of a maximal-effort plantarflexion contraction was employed to test the implications of muscle remodeling on single-leg heel raise function. Subject-specific fascicle length and pennation measurements explained deficits in ankle work and power that strongly agreed with experimentally measured values using motion capture. These preliminary findings support the hypothesis that skeletal muscle goes extensively remodels in response to a ruptured tendon, which reduces the amount of work and power the joint can generate. This multidisciplinary framework of biomechanical, imaging, and computational modeling provides a unique platform for studying the complex interactions between structure and function in patients recovering from Achilles tendon injuries.

scholarly journals Gastrocnemius Muscle Structure Remodels Within the First Month Following Acute Achilles Tendon Rupture

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0032
Author(s):  
Kathryn M O’Connor ◽  
Todd J. Hullfish ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Gastrocnemius Muscle ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Pennation Angle ◽  
Medial Gastrocnemius ◽  
Muscle Quality ◽  
Fascicle Length ◽  
Muscle Structure ◽  
Tendon Ruptures

Category: Sports, Trauma, Achilles Tendon Introduction/Purpose: Two out of three patients Achilles tendon ruptures have limited plantarflexor function 1-year following Achilles tendon rupture. While tendon elongation has been reported as a possible mechanism of functional deficits, the effects of rupture on plantarflexor muscle structure has not been as rigorously investigated. A recent study found that gastrocnemius fascicle length was decreased 6-months following Achilles tendon rupture compared to the uninjured limb. However, the changes in muscle structure following the first month of injury – when the healing tendon is most susceptible to elongation – has not yet been established. The purpose of this study was to quantify the structural changes to the medial gastrocnemius in patients who suffered acute Achilles tendon ruptures and were treated non-operatively. Methods: To test our hypothesis that plantarflexor structure would undergo rapid remodeling following Achilles tendon rupture, we quantified muscle structure in ten patients (9 male, Age: 44 ± 12; BMI: 28.6 ± 6.5) who provide informed written consent in this IRB approved study. We acquired B-mode ultrasound images of the medial gastrocnemius muscle at the initial presentation (week 0), two weeks, and four weeks following the injury. The same investigator acquired all the ultrasound images and measured fascicle length, pennation angle, muscle thickness, and echo intensity. These measurements had a coefficient of variation less than 10%. We compared these structural measurements of the injured muscle at each time point with the contralateral muscle scans at the initial presentation using paired t-tests. Results: Gastrocnemius muscle structure following an acute Achilles tendon rupture differed with the healthy-contralateral muscle throughout the first four weeks following injury (Figure). Fascicle length was 15% shorter (P < 0.001) and pennation angle was 21% greater (P < 0.001) at the presentation of injury (week 0). These differences in fascicle length (P < 0.001) and pennation angle persisted throughout the 4 weeks after the injury (P < 0.008). Muscle thickness changes were not detected at any of the post-injury visits. Muscle quality, measured as mean echo intensity, was 8% lower in the injured limb immediately (P= 0.008) and 11% lower 2 weeks following injury (P < 0.001). At week 4 muscle quality had returned to within 1% of the contralateral limb (P = 0.393). Conclusion: Our findings support our hypothesis that the gastrocnemius muscle fascicles of the affected side would demonstrate shorter length and greater pennation angle than the contralateral control muscle. These findings are a preliminary set of data from a larger clinical cohort of patients that were enrolled in an ongoing 1-year long prospective study. Achilles tendon ruptures elicit rapid changes in the configuration and quality of the medial gastrocnemius, which may explain long-term functional deficits.

Kinematic and Neuromuscular Changes of the Gait Pattern After Achilles Tendon Rupture

1997 ◽  
Vol 18 (6) ◽  
pp. 339-341 ◽  
Author(s):  
Daniela Neumann ◽  
Lutz Vogt ◽  
Winfried Banzer ◽  
Udo Schreiber
Keyword(s):  
Achilles Tendon ◽  
Gastrocnemius Muscle ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Gait Pattern ◽  
Control Group ◽  
Motor Patterns ◽  
Lateral Gastrocnemius ◽  
Functional Movement ◽  
Ankle Motion

After long immobilization periods in equinovalgus with operated Achilles tendon rupture, long-lasting changes of motor patterns in functional movement can be expected. In the present study, possible alterations in gait pattern have been analyzed based on kinematic and neuromuscular parameters. Ten patients 1 year after surgery and a healthy control group performed 10 gait cycles in natural walking cadence. Ankle motion, pressure distribution, and electromyographic data were recorded and analyzed in defined phases. Kinematic and neuromuscular changes are still evident 1 year after surgery with a temporal phase shift and a neuromuscular deficit of the lateral gastrocnemius muscle. The objective of rehabilitation should be the facilitation of the temporal innervation pattern of the lateral gastrocnemius muscle in the functional movement.

A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture

2009 ◽  
Vol 18 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Karin Grävare Silbernagel ◽  
Katarina Nilsson-Helander ◽  
Roland Thomeé ◽  
Bengt I. Eriksson ◽  
Jón Karlsson
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Functional Deficits

scholarly journals In vivo intramuscular fascicle-aponeuroses dynamics of the human medial gastrocnemius during plantarflexion and dorsiflexion of the foot

2009 ◽  
Vol 107 (4) ◽  
pp. 1276-1284 ◽  
Author(s):  
David D. Shin ◽  
John A. Hodgson ◽  
V. Reggie Edgerton ◽  
Shantanu Sinha
Keyword(s):  
Gastrocnemius Muscle ◽  
Imaging Techniques ◽  
High Stress ◽  
Proximal Region ◽  
Pennation Angle ◽  
Medial Gastrocnemius ◽  
Stress Concentrations ◽  
Fascicle Length ◽  
Medial Gastrocnemius Muscle

Velocity-encoded phase-contrast magnetic resonance (MR) imaging techniques and a computer-controlled MR-compatible foot pedal device were used to investigate the medial gastrocnemius muscle and aponeurosis deformations during passive and active eccentric movements of the plantarflexors. Intrafascicular strain, measured as the ratio of strain in the fascicle segment at its insertion to strain at its origin, was nonuniform along the proximodistal axis of the muscle ( P < 0.01), progressively increasing from the proximal to distal direction. The high intrafascicular strain regions appeared to correlate with the muscle regions that are likely to encounter high stress concentrations, i.e., the regions where the muscle physiological cross section decreases close to the tendons. The architectural gear ratio, i.e., the mechanical amplification ratio of fascicle length displacement to that of tendon/aponeuroses in a pennate muscle, also exhibited significant regional differences, with the highest ratios in the proximal region of the muscle accompanied by a higher initial pennation angle and a larger range of fascicular rotation about the origin. Values close to unity in the distal region of the muscle suggest that the aponeurosis separation may decrease in this region. Fascicle length and pennation angle changes were significantly influenced by force generation in the muscle, probably due to a shortening of the loaded muscle fibers relative to a passive condition. Overall, our data illustrate significant proximodistal intramuscular heterogeneity as supported by a regionally variable end-to-end strain ratio of fascicles and angle changes in the medial gastrocnemius muscle during passive and active ankle movements. These observations emphasize the need to reassess current conceptual models of muscle-tendon mechanics.

Major functional deficits persist 2 years after acute Achilles tendon rupture

2011 ◽  
Vol 19 (8) ◽  
pp. 1385-1393 ◽  
Author(s):  
Nicklas Olsson ◽  
Katarina Nilsson-Helander ◽  
Jón Karlsson ◽  
Bengt I. Eriksson ◽  
Roland Thomée ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Functional Deficits

scholarly journals Midterm functional performance following open surgical repair of acute Achilles tendon rupture

2021 ◽  
Author(s):  
Markus Wenning ◽  
Marlene Mauch ◽  
Albrecht Heitner ◽  
Paul Streicher ◽  
Ramona Ritzmann ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Functional Performance ◽  
Achilles Tendon Rupture ◽  
Anatomical Reconstruction ◽  
Open Surgical Repair ◽  
Functional Deficits ◽  
Post Surgery ◽  
Patient Reported

Abstract Introduction Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair. Materials and Methods This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. Results At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p < 0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing. Conclusion In summary, there are persisting functional deficits at > 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. Level of evidence III, retrospective cohort study

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

2018 ◽  
Author(s):  
Todd J. Hullfish ◽  
Kathryn M O’Connor ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Muscle Thickness ◽  
Pennation Angle ◽  
Medial Gastrocnemius ◽  
Ultrasound Images ◽  
Echo Intensity ◽  
Post Injury ◽  
Fascicle Length ◽  
Clinical Visit ◽  
Tendon Ruptures

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

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