scholarly journals Original Algorithm of Rehabilitation Protocol with Use of Ultrasound - Study Based on Achilles Tendon Reconstruction Cases

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0016
Author(s):  
Agnieszka Barbara Rosińska ◽  
Beata Ciszkowska-Łysoń ◽  
Robert Śmigielski
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Functional Recovery ◽  
Gastrocnemius Muscle ◽  
Ultrasound Examination ◽  
Fat Body ◽  
Plantar Flexion ◽  
Medical Examination ◽  
Rehabilitation Protocol ◽  
Achilles Tendon Reconstruction

Objectives: The study was conducted in order to indicate the usefulness of an ultrasound examination in physiotherapy of patients who underwent Achilles tendon reconstruction. The aim was to eliminate the risk of the procedure’s common complication, i.e.: the formation of adhesions between surrounding tissues and the tendon. Methods: This study analyses 10 cases of anatomical reconstruction of the Achilles tendon. In all cases the surgeon, the physical therapist and the rehabilitation protocol were the same. The algorithm: 1. The weekly protocol included: • the evaluation of: ROM, gliding, tissues swelling, tendon ripple, bursa and fat body movement, possible gaps, and vascularity; • medical examination including: observation, palpation, and ultrasound examination. 2. Every PT session was preluded by an examination including: observation, palpation, and ultrasound evaluation. 3. The US examination was performed to evaluate the functioning of tissues in regard to the tendon’s healing stage. • 2-3 weeks after the surgery: the assessment of gliding during passive plantar flexion, the examination included the use of modified Thompson’s test; • after 3 weeks: the assessment of tendon tension and the isometric plantar flexion strength of the medial gastrocnemius muscle; • 3rd and 6th week: the assessment of swelling, vascularity (before and after the PT session including the cooling of the tendon), Kager’s triangle fat body assessment, and active gliding evaluation, testing the gastrocnemius muscle strength during active movement, • from 6th week until the end of physiotherapy: the evaluation of tendon gliding and gastrocnemius’ strength (body weight bearing); • the final US examination performed by the radiology specialist in the 12th week after the surgery, the assessment of gliding and muscle strength. Results: During the final medical examination performed by the doctor in 12th week after the surgery, there were no tendon adhesions between the tendon and surrounding tissues that would limit the tendon’s gliding within its sheath. The weekly US examination helped while choosing appropriate physical therapy methods that increased the functional recovery of the Achilles tendon. Conclusion: 1. The use of ultrasound device during each PT session enables the therapist to choose appropriate methods in order to optimise the rehabilitation process depending on the current condition of the patient. This approach creates good conditions for the optimal functional recovery. 2. The ultrasound works like a biofeedback.

scholarly journals Mechanical properties of tendon and aponeurosis of human gastrocnemius muscle in vivo

2001 ◽  
Vol 90 (5) ◽  
pp. 1671-1678 ◽  
Author(s):  
Tadashi Muramatsu ◽  
Tetsuro Muraoka ◽  
Daisuke Takeshita ◽  
Yasuo Kawakami ◽  
Yuichi Hirano ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Achilles Tendon ◽  
Gastrocnemius Muscle ◽  
Plantar Flexion ◽  
Medial Gastrocnemius ◽  
Significant Difference ◽  
Functional Implications ◽  
Male Subjects ◽  
Maximal Strain

Load-strain characteristics of tendinous tissues (Achilles tendon and aponeurosis) were determined in vivo for human medial gastrocnemius (MG) muscle. Seven male subjects exerted isometric plantar flexion torque while the elongation of tendinous tissues of MG was determined from the tendinous movements by using ultrasonography. The maximal strain of the Achilles tendon and aponeurosis, estimated separately from the elongation data, was 5.1 ± 1.1 and 5.9 ± 1.6%, respectively. There was no significant difference in strain between the Achilles tendon and aponeurosis. In addition, no significant difference in strain was observed between the proximal and distal regions of the aponeurosis. The results indicate that tendinous tissues of the MG are homogenously stretched along their lengths by muscle contraction, which has functional implications for the operation of the human MG muscle-tendon unit in vivo.

scholarly journals REHABILITATION PROTOCOL AFTER ACHILLES TENDON RECONSTRUCTION WITH AN AUTOLOGOUS HAMSTRING GRAFT

2021 ◽  
Vol 37 (37) ◽  
pp. 43-51
Author(s):  
Bartosz Kiedrowski ◽  
Paweł Bąkowski ◽  
Łukasz Stołowski ◽  
Jakub Kaszyński ◽  
Gino Kerkhoffs ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Isometric Exercise ◽  
Rehabilitation Program ◽  
Gracilis Muscle ◽  
Hamstring Graft ◽  
Sports Activity ◽  
Rehabilitation Protocol ◽  
Tendon Reconstruction ◽  
Biomechanical Assessment ◽  
Achilles Tendon Reconstruction

Introduction One of the treatment options in chronic damage or unsuccessful suturing of the Achilles tendon is a surgical treatment consisting of its reconstruction using the tendon of semitendinosus and gracilis muscle. The multitude of types of reconstruction causes discrepancies in rehabilitation protocols. All of them aim to return to full functional fitness as the ultimate goal. Aim This study aims to present the proprietary rehabilitation protocol after Achilles tendon reconstruction using the tendon of semitendinosus and gracilis muscle. Material and methods The presented rehabilitation program lasts about 12 months and is divided into six stages. Stage I consists of standing up and anticoagulant exercises, and isometric exercise. Stage II, lasting up to 2 weeks after the procedure, consists of the patient’s independent work in the home environment. Stage III, lasting up to 4 weeks, involves learning to walk and putting weight on the limb in a cam Walker. In the third stage, after the postoperative wounds have healed, exercises in water conditions are started. Stage IV, lasting from 4 weeks after the operation, involves loading the limb with support, increasing the range of dorsiflexion motion, and progressive muscle strengthening. Stage V, which lasts up to 8–12 months after surgery, eliminates functional deficits and prepares the patient for a functional biomechanical assessment. Stage VI is the stage of work on the compensation of deficits resulting from the analysis of the results of the functional biomechanical assessment necessary to return to the full sports activity. Results The rehabilitation time, in accordance with the assumptions of the above protocol, is 8–12 months. After this time, the patient should proceed to a functional biomechanical assessment. Discussion and conclusions The rehabilitation protocol presented by our team describes in detail the stages of post-operative rehabilitation after Achilles tendon reconstruction with a hamstring graft. It provides the conditions necessary for the patient to meet before starting the next phase and returning to sport. Our requirements are consistent with the assumptions available in the scientific base. Keywords: Achilles tendon reconstruction, return to sport, rehabilitation program.

Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments

2017 ◽  
Vol 45 (6) ◽  
pp. 1395-1404 ◽  
Author(s):  
Juuso Heikkinen ◽  
Iikka Lantto ◽  
Tapio Flinkkila ◽  
Pasi Ohtonen ◽  
Jaakko Niinimaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Muscle Strength ◽  
Achilles Tendon ◽  
Study Groups ◽  
Fatty Degeneration ◽  
Calf Muscle ◽  
Nonsurgical Treatment ◽  
Rehabilitation Protocol ◽  
The Mean ◽  
Calf Muscles

Background: It remains controversial whether nonsurgical or surgical treatment provides better calf muscle strength recovery after an acute Achilles tendon rupture (ATR). Recent evidence has suggested that surgery might surpass nonsurgical treatment in restoring strength after an ATR. Purpose: To assess whether magnetic resonance imaging (MRI) findings could explain calf muscle strength deficits and the difference between nonsurgical and surgical treatments in restoring calf muscle strength. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From 2009 to 2013, 60 patients with acute ATRs were randomized to surgery or nonsurgical treatment with an identical rehabilitation protocol. The primary outcome measure was the volume of calf muscles assessed using MRI at 3 and 18 months. The secondary outcome measures included fatty degeneration of the calf muscles and length of the affected Achilles tendon. Additionally, isokinetic plantarflexion strength was measured in both legs. Results: At 3 months, the study groups showed no differences in muscle volumes or fatty degeneration. However, at 18 months, the mean differences between affected and healthy soleus muscle volumes were 83.2 cm3 (17.7%) after surgery and 115.5 cm3 (24.8%) after nonsurgical treatment (difference between means, 33.1 cm3; 95% CI, 1.3-65.0; P = .042). The study groups were not substantially different in the volumes or fatty degeneration of other muscles. From 3 to 18 months, compensatory hypertrophy was detected in the flexor hallucis longus (FHL) and deep flexors in both groups. In the nonsurgical treatment group, the mean difference between affected and healthy FHL muscle volumes was −9.3 cm3 (12%) and in the surgical treatment group was −8.4 cm3 (10%) ( P ≤ .001). At 18 months, Achilles tendons were, on average, 19 mm longer in patients treated nonsurgically compared with patients treated surgically ( P < .001). At 18 months, surgically treated patients demonstrated 10% to 18% greater strength results ( P = .037). Calf muscle isokinetic strength deficits for the entire range of ankle motion correlated with soleus atrophy (ρ = 0.449-0.611; P < .001). Conclusion: Treating ATRs nonsurgically with a functional rehabilitation protocol resulted in greater soleus muscle atrophy compared with surgical treatment. The mean Achilles tendon length was 19 mm longer after nonsurgical treatment than after the surgical treatment of ATRs. These structural changes partly explained the 10% to 18% greater calf muscle strength observed in patients treated with surgery compared with those treated nonsurgically. Registration: NCT02012803 ( ClinicalTrials.gov identifier).

Elastic properties of human Achilles tendon are correlated to muscle strength

2005 ◽  
Vol 99 (2) ◽  
pp. 665-669 ◽  
Author(s):  
Tetsuro Muraoka ◽  
Tadashi Muramatsu ◽  
Tetsuo Fukunaga ◽  
Hiroaki Kanehisa
Keyword(s):  
Mechanical Properties ◽  
Muscle Strength ◽  
Achilles Tendon ◽  
Elastic Energy ◽  
Plantar Flexion ◽  
Triceps Surae ◽  
Medial Gastrocnemius ◽  
Myotendinous Junction ◽  
Men And Women ◽  
The Difference

The purpose of this study was to investigate whether the mechanical properties of the Achilles tendon were correlated to muscle strength in the triceps surae in humans. Twenty-four men and twelve women exerted maximal voluntary isometric plantar flexion (MVIP) torque. The elongation (ΔX) and strain of the Achilles tendon (ε), the proximal part of which is the composite of the gastrocnemius tendon and the soleus aponeurosis, at MVIP were determined from the displacement of the distal myotendinous junction of the medial gastrocnemius using ultrasonography. The Achilles tendon force at MVIP (F) was calculated from the MVIP torque and the Achilles tendon moment arm. There were no significant differences in either the F-ΔX or F-ε relationships between men and women. ΔX and ε were 9.8 ± 2.6 mm and 5.3 ± 1.6%, respectively, and were positively correlated to F ( r = 0.39, P < 0.05; r = 0.39, P < 0.05), which meant that subjects with greater muscle strength could store more elastic energy in the tendon. The regression y-intercepts for the F-ΔX ( P < 0.01) and F-ε ( P < 0.05) relationship were significantly positive. These results might indicate that the Achilles tendon was stiffer in subjects with greater muscle strength, which may play a role in reducing the probability of tendon strain injuries. It was suggested that the Achilles tendon of subjects with greater muscle strength did not impair the potential for storing elastic energy in tendons and may be able to deliver the greater force supplied from a stronger muscle more efficiently. Furthermore, the difference in the Achilles tendon mechanical properties between men and women seemed to be correlated to the difference in muscle strength rather than gender.

scholarly journals Relationship Between Recurrent Adductus Deformity of the Forefoot and Achilles Tendon Elongation Following Ponseti Treatment in Children with Idiopathic Clubfoot

2020 ◽  
Author(s):  
Mehmet Demirel ◽  
Fuat BİLGİLİ ◽  
Çiğdem ÖZKARA BİLGİLİ ◽  
Serkan Bayram ◽  
Ömer Naci Ergin ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Plantar Flexion ◽  
Retrospective Chart Review ◽  
Significant Negative Correlation ◽  
Underlying Mechanism ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Tendon Elongation ◽  
Metatarsus Adductus

Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. Nevertheless, this possible underlying mechanism behind recurrences has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by Ponseti method. Methods: A retrospective chart review was performed on 20 children (14 boys, 6 girls; mean age: 7 years; age range: 5-9) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was ultrasonographically measured. Results: The plantar flexion/dorsiflexion ratio was lower on the involved side (p = 0.001). No significant differences in the strength ratio of inversion/eversion were found (p = 0.4). No difference was observed in lengths of tibialis anterior and posterior tendon (p = 0,1), but Achilles tendon was longer on the involved side (p = 0.001; p &lt; 0.01). A significant negative correlation was discovered between involved/uninvolved Achilles tendon length ratios and involved/uninvolved plantar flexion strength ratios (r = −0.524; p = 0.02) Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with the relapsed forefoot adduction treated by the Ponseti technique.

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

scholarly journals Delayed Rehabilitation Protocol after Rotator Cuff Repair

Osteology ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 29-38
Author(s):  
Alessandra Berton ◽  
Sergio De Salvatore ◽  
Vincenzo Candela ◽  
Gabriele Cortina ◽  
Daniela Lo Presti ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Internal Rotation ◽  
Outcome Measures ◽  
Rotator Cuff Repair ◽  
External Rotation ◽  
Shoulder Function ◽  
Rehabilitation Protocol ◽  
Patient Reported ◽  
Cuff Repair

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, atraumatic and full-thickness supraspinatus tendon tear, were involved. According to our rehabilitation protocol, during the first four postoperative weeks, the arm was supported with an abduction sling pillow, and pendulum exercises, table slide and active elbow extension and flexion were conceded. Outcome measures (Oxford shoulder score (OSS), simple shoulder test (SST), patient-reported satisfaction), shoulder function (range of motion (ROM) and muscle strength), and MRI examination were evaluated. The mean OSS score and SST score increased from 16 to 30.2 and from 5.3 to 11.4, respectively. Patient-reported satisfaction was 96%. At 12 months, patients improved ROM and muscle strength. Postoperative passive anterior elevation was 176; external rotation averaged 47; internal rotation was 90. Postoperative muscle strength during anterior elevation was 8.3 ± 2.2 kg, internal rotation 6.8 ± 3 kg, external rotation 5.5 ± 2.3 kg. Five out of seven patients with recurrent tears evaluated their results as satisfactory. They reported improvements in terms of OSS and SST mean scores despite recurrent tears; therefore, they did not undergo revision surgery. The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI.

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