Changes in Tendon Elongation and Muscle Atrophy Over Time After Achilles Tendon Rupture Repair: A Prospective Cohort Study on the Effects of Early Functional Mobilization

Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated with EFM or standard treatment after ATR repair. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study included 86 patients (20 women) with ATR repair who had a mean (SD) age of 39.3 (8.2) years and were part of a larger prospective randomized controlled trial. Patients were postoperatively randomized to immediate postoperative weightbearing and ankle motion (EFM group) or to immobilization in a below-knee plaster cast for 2 weeks (control group). Patient-reported and functional outcomes were assessed at 6 and 12 months with the Achilles Tendon Total Rupture Score and the heel-rise test for endurance. At 2 and 6 weeks and 6 and 12 months postoperatively, B-mode ultrasound imaging was performed to assess the length and cross-sectional area (CSA) of the Achilles tendon, the gastrocnemius CSA, as well as the thickness of soleus. Results: The Achilles Tendon Total Rupture Score for the EFM and control groups were 65.8 (18.7) and 56.8 (20.1; P = .045), respectively, at 6 months and 79.6 (15.8) and 78.9 (17.2; P = .87), respectively, at 12 months. At 2 weeks, tendon elongation was significantly more pronounced in the EFM group as compared with the control group (mean side-to-side difference, 1.88 cm vs 0.71 cm; P = .005). Subsequently, tendon elongation increased in the control group while it decreased in the EFM group so that at 6 and 12 months no significant differences between groups were found. Mean Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the EFM group (n = 55) and 1.67 (0.92) cm for the control group (n = 27), with a mean difference of 0.06 cm (95% CI, 0.54 to –0.42; P = .80). Achilles tendon CSA and calf muscle atrophy displayed no significant differences between the groups; however, significant changes were demonstrated over time ( P ≤ .001) in both groups. Conclusion: EFM results in more Achilles tendon elongation at early healing, but this difference subsides over time. EFM does not seem to affect patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy. Registration: NCT02318472 (ClinicalTrials.gov identifier).

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Calf Muscle Atrophy and Achilles Tendon Elongation After Acute Achilles Tendon Rupture

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2017.08.153 ◽

2017 ◽

Vol 33 (10) ◽

pp. e129-e130 ◽

Cited By ~ 3

Author(s):

Juuso Heikkinen ◽

Iikka Lantto ◽

Tapio Flinkkila ◽

Pertti Siira ◽

Vesa Laine ◽

...

Keyword(s):

Achilles Tendon ◽

Muscle Atrophy ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Calf Muscle ◽

Tendon Elongation

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Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.16.01491 ◽

2017 ◽

Vol 99A (18) ◽

pp. 1509-1515 ◽

Cited By ~ 45

Author(s):

Juuso Heikkinen ◽

Iikka Lantto ◽

Juuso Piilonen ◽

Tapio Flinkkilä ◽

Pasi Ohtonen ◽

...

Keyword(s):

Achilles Tendon ◽

Muscle Atrophy ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Calf Muscle ◽

Tendon Length

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Effect of Achilles Tendon Rupture on Player Performance and Longevity in Women’s National Basketball Association Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989982 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712198998

Author(s):

Joseph S. Tramer ◽

Lafi S. Khalil ◽

Patrick Buckley ◽

Alexander Ziedas ◽

Patricia A. Kolowich ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

National Basketball Association ◽

Return To Play ◽

Control Group ◽

Healthy Controls ◽

Career Longevity ◽

Women's National Basketball Association ◽

Player Performance

Background:Women’s National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR).Purpose:To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes.Study Design:Cohort study; Level of evidence, 3.Methods:WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups.Results:Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (±SD) of 12.5 ± 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 ± 6.9 fewer games, starting in 12.7 ± 15.4 fewer games, and playing 10.2 ± 9.1 fewer minutes per game ( P < .05 for all). After the index date of injury, the players with Achilles repair played 2.1 ± 1.2 more years in the WNBA, while control players played 5.35 ± 3.2 years ( P < .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 ± 5.3 vs 11.0 ± 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls ( P < .05 for both).Conclusion:The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls.

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Return to Play Following Achilles Tendon Rupture in NFL Players Based on Position

Foot & Ankle Specialist ◽

10.1177/19386400211040351 ◽

2021 ◽

pp. 193864002110403

Author(s):

Dane Barton ◽

Aditya Manoharan ◽

Ansab Khwaja ◽

Jacob Sorenson ◽

Michel Taylor

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

National Football League ◽

Achilles Tendon Rupture ◽

Epidemiologic Study ◽

Return To Play ◽

Control Group ◽

Study Cohort ◽

History Of ◽

Level 3

Background: The purpose of this study was to determine the return-to-play (RTP) rate and postinjury performance after Achilles tendon (AT) ruptures in National Football League (NFL) skill position players. Methods: The study included NFL skill positions with an AT rupture between the 2009-2010 and 2015-2016 seasons. Performance data were collected and compared against a matched control group. RTP was defined as playing in at least 1 game after repair. Results: RTP rate was 57% for the study cohort. The tight ends (TEs) had the highest RTP rate at 71% while the wide receivers (WRs) had the lowest RTP rate at 38%. Compared with the control group, WRs with successful RTP had significantly less receptions per game ( P = .01). For defensive players with RTP there were significant decreases in postrepair performance in tackles, passes defended, and fumbles forced/recovered compared with the control group. Conclusion: A total of 57% of players achieved RTP with WRs and running backs (RBs) having the lowest RTP rates and TEs and linebackers (LBs) having the highest RTP rates. RBs, defensive backs (DBs), and LBs with successful RTP had decreased performance in all categories. This updated information may be helpful for athletes, physicians, scouts, and coaches in evaluating players with a history of AT rupture. Levels of Evidence: Analytic, level 3, retrospective cohort study, Epidemiologic study

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Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2016-000114 ◽

2016 ◽

Vol 2 (1) ◽

pp. e000114 ◽

Cited By ~ 6

Author(s):

Md Abdul Alim ◽

Simon Svedman ◽

Gunnar Edman ◽

Paul W Ackermann

Keyword(s):

Patient Outcome ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture

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Tendon elongation and muscle function after repair of Achilles tendon rupture

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/j.1600-0838.1992.tb00334.x ◽

2007 ◽

Vol 2 (3) ◽

pp. 139-142 ◽

Cited By ~ 7

Author(s):

T. Wredmark ◽

C. A. Carlstedt

Keyword(s):

Achilles Tendon ◽

Muscle Function ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Elongation

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Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/0363546518793655 ◽

2018 ◽

Vol 46 (12) ◽

pp. 2929-2934 ◽

Cited By ~ 10

Author(s):

Simon Svedman ◽

Robin Juthberg ◽

Gunnar Edman ◽

Paul W. Ackermann

Keyword(s):

Patient Outcome ◽

Adverse Events ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Patient Reported Outcome ◽

Evidence Based ◽

Treatment Protocols ◽

Good Outcome ◽

Patient Reported

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred twenty-eight patients with ATR who were treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on availability of the operating theater, and neither surgeon nor patient could influence the TTS. Patients were assigned to 1 of 3 groups: short TTS (<48 hours), intermediate TTS (48-72 hours), and long TTS (>72 hours). Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score, with scores higher than 80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (perioperative and postoperative) and deep venous thrombosis were assessed. Results: Short TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared with 44% (95% CI, 33%-56%) of the patients with long TTS ( P = .002), with the intermediate TTS group in between, 63% (95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS, 1.4% (95% CI, 1%-4%) compared with those with intermediate TTS, 11% (95% CI, 2%-21%) ( P = .035) and those with long TTS, 14.8% (95% CI, 7%-23%) ( P = .003). The risk of sustaining a deep venous thrombosis was not statistically significantly different among the 3 groups ( P = .15). Conclusion: Patients with acute ATR undergoing operation within 48 hours after injury had better outcomes and a lower number of adverse events compared with patients undergoing operation after 72 hours. These results align with evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols. Registration: NTC01317160 (ClinicalTrials.gov identifier).

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Use of ankle resting angle as a surrogate for tendon elongation in individuals following Achilles tendon rupture

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000182 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Heather Gotha ◽

Jennifer Zellers ◽

Karin Silbernagel

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Cost Effective ◽

Cross Sectional Study ◽

Plantar Flexors ◽

Cross Sectional ◽

Tendon Length ◽

Tendon Elongation ◽

The Relationship

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.

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