scholarly journals Can Weakness in End-Range Plantar Flexion After Achilles Tendon Repair Be Prevented?

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877403 ◽  
Author(s):  
Karl F. Orishimo ◽  
Sidse Schwartz-Balle ◽  
Timothy F. Tyler ◽  
Malachy P. McHugh ◽  
Benjamin B. Bedford ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Plantar Flexion ◽  
Tendon Repair ◽  
Joint Stiffness ◽  
Case Series ◽  
Neutral Position ◽  
Passive Stiffness ◽  
Force Transmission ◽  
Passive Joint ◽  
Achilles Tendon Repair

Background: Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair are thought to reflect increased tendon compliance or tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion for the first 12 weeks after surgery. Hypothesis: Using stronger repairs and avoiding stretching into dorsiflexion would eliminate end-range plantar flexion weakness and normalize passive stiffness. Study Design: Case series; Level of evidence, 4. Methods: Achilles repairs with epitendinous augmentation were performed on 18 patients. Plantar flexion torque, dorsiflexion range of motion (ROM), passive joint stiffness, and standing single-legged heel rise on a decline were assessed at 43 ± 24 months after surgery (range, 9 months to 8 years). Maximum isometric plantar flexion torque was measured at 20° and 10° of dorsiflexion, neutral position, and 10° and 20° of plantar flexion. Passive dorsiflexion ROM was measured with a goniometer. Passive joint stiffness was computed from the increase in passive torque from 10° to 20° of dorsiflexion. Tendon thickness was measured by use of digital calipers. Plantar flexion electromyographic (EMG) data were recorded during strength and functional tests. Analysis of variance and chi-square tests were used to assess weakness and function. Results: Marked weakness was evident on the involved side at 20° of plantar flexion (deficit, 26% ± 18%; P < .001), with no weakness at 20° of dorsiflexion (deficit, 6% ± 17%; P = .390). Dorsiflexion ROM was decreased 5.5° ± 8° ( P = .015), and tendon width was 8 ± 3 mm greater on the involved side ( P < .001). Passive joint stiffness was similar between the involved and noninvolved sides. Only 2 of 18 patients could perform a decline heel rise on the involved side compared with 18 of 18 on the noninvolved side ( P = .01). No difference in EMG amplitude was found between the involved and noninvolved sides during the strength or heel rise tests. Conclusion: The use of stronger repair techniques and attempts to limit tendon elongation by avoiding dorsiflexion stretching did not eliminate weakness in end-range plantar flexion. EMG data confirmed that end-range weakness was not due to neural inhibition. Physiological changes that alter the force transmission capability of the healing tendon may be responsible for this continued impairment. This weakness has implications for high-demand jumping and sprinting after Achilles tendon repair.

scholarly journals Arthroscopically-Asissted Achilles Tendon Repair; Long-Term Results

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0022
Author(s):  
Akın Turgut ◽  
Mert Zeynel Asfuroğlu
Keyword(s):  
Achilles Tendon ◽  
Range Of Motion ◽  
Sural Nerve ◽  
Plantar Flexion ◽  
Tendon Repair ◽  
Long Term Results ◽  
Calf Circumference ◽  
Achilles Tendon Repair ◽  
Arthroscopically Assisted

Objectives: The ruptures of the Achilles tendon (AT) are relatively common. Since there is no consensus on the best method of the repair of the AT; the treatment is determined on the preference of the surgeon and the patient. The study evaluating the cadaveric and short term clinical results done by our clinic in 2002, has shown us that arthroscopically Achilles tendon repair can be good choise in achilles tendon ruptures. Methods: Fortyfour patients who underwent arthroscopically assisted achilles tendon repair during 1997-2011 in Osmangazi University Orthopaedics and Traumatology Department were retrospectively observed. The mean follow-up time was 69,7 months. One of patients had bilateral rupture. The diagnosis was based on loss of plantar flexion strength, palpation of the gap in the tendon, and a positive Thompson test. MRI and USG were used when needed. The ruptures were left-sided in nineteen patients and right-sided in twentysix. The cause of the rupture was recreational sports activity in thirtyeight, fall from height in four, missing a step in a staircase in two. Return the regular activity, ankle range of motion as compared with the opposite side, calf circumference, and ability to walk and stand tiptoe were recorded. All patients were operated on within 2-32 days after the rupture. Thirtysix operations were performed under spinal anesthesia and eight operations were performed under general anesthesia. Tourniquet was always used. Before starting the procedure, the rupture site and location of the gap are marked. Using the common videoarthroscopic instruments, a 70 degrees scope was inserted into the AT through the stab incision made previously, and the torn ends of the tendon were visualized with plantar flexion an extension of the ankle. After the visualization of the torn ends of the tendon and repair by the technique of Ma and Griffith care was focused to contact the ends of the tendon anatomically; then the sutures were knotted. A short leg circular cast with the ankle in slight plantar flexion was applied. American Orthopaedics Foot-Ankle Society (AOFAS) score was used to evaluate the long-term results.. Results: All patients had satisfactory results that no reruptures had occurred. No significant difference in range of motion of the ankle and calf circumference between the opposite sides was observed in any patient. All patients could walk and stand on tiptoe. AOFAS mean score was 94.5 (65-100). The interval from injury to return to regular work and activities was 8-10 weeks. All the patients were able to return back to their activity level before surgery. In three patients temporary sural hypoestesia, in one patient permanent sural hipoestesia and in one patient wound enfection appeared. No sensory deficit was detected in the temporary sural hypoestesia patients after postoperative second year controls. Medical care was supported to the patient with the wound enfection and the enfection was under control in the early stages. Conclusion: In summary; arthroscopically-assisted percutaneous repair of AT appears to overcome some certain problems of open, conservative and percutaneous techniques; but the neurovascular structure damage risk especially the sural nerve remains a potent problem. Accurate knowledge of the anatomy appears to be a solution. Novel percutaneous repairs have been promising to minimize the risk of sural nerve damage.

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

2020 ◽  
pp. 107110072096249
Author(s):  
Craig C. Akoh ◽  
Amanda Fletcher ◽  
Akhil Sharma ◽  
Selene G. Parekh
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Repair ◽  
Case Series ◽  
Postoperative Outcome ◽  
Foot And Ankle ◽  
Achilles Tendon Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

scholarly journals Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988335
Author(s):  
Malachy P. McHugh ◽  
Karl F. Orishimo ◽  
Ian J. Kremenic ◽  
Julia Adelman ◽  
Stephen J. Nicholas
Keyword(s):  
Achilles Tendon ◽  
Muscle Fiber ◽  
Fourier Transforms ◽  
Maximum Voluntary Contraction ◽  
Tendon Repair ◽  
Case Series ◽  
Medial Gastrocnemius ◽  
Level Of Evidence ◽  
Achilles Tendon Repair ◽  
Tendon Elongation

Background: Weakness in end-range plantarflexion has been demonstrated after Achilles tendon repair and may be because of excessive tendon elongation. The mean frequency (MNF) of surface electromyogram (EMG) data during isometric maximum voluntary contraction (MVC) increases with muscle fiber shortening. Hypothesis: During isometric plantarflexion, MNF during MVCs will be higher on the involved side compared with the uninvolved side after Achilles tendon repair because of excessive tendon elongation and greater muscle fiber shortening. Study Design: Case series; Level of evidence, 4. Methods: Isometric plantarflexion MVC torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantarflexion in 17 patients (15 men, 2 women; mean age, 39 ± 9 years) at a mean 43 ± 26 months after surgery. Surface EMG signals were recorded during strength tests. MNF was calculated from fast Fourier transforms of medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) EMG signals. Results: Patients had marked weakness on the involved side versus the uninvolved side in 20° plantarflexion (deficit, 28% ± 18%; P < .001) but no significant weakness in 20° dorsiflexion (deficit, 8% ± 15%; P = .195). MNF increased when moving from dorsiflexion to plantarflexion ( P < .001), but overall, it was not different between the involved and uninvolved sides ( P = .195). However, differences in MNF between the involved and uninvolved sides were apparent in patients with marked weakness. At 10° plantarflexion, 8 of 17 patients had marked weakness (>20% deficit). MNF at 10° plantarflexion was significantly higher on the involved side versus the uninvolved side in patients with weakness, but this was not apparent in patients with no weakness (side by group, P = .012). Mean MNF at 10° plantarflexion across the 3 muscles was 13% higher on the involved side versus the uninvolved side in patients with weakness ( P = .012) versus 3% lower in patients with no weakness ( P = .522). Conclusion: Higher MNF on the involved side versus the uninvolved side in patients with significant plantarflexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily because of excessive lengthening of the repaired Achilles tendon. If weakness was simply because of atrophy, a lower MNF would have been expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantarflexion after Achilles repair.

scholarly journals Acute Effects of Dermal Suction on Passive Muscle and Joint Stiffness

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1483
Author(s):  
Shota Enomoto ◽  
Tomonari Shibutani ◽  
Yu Akihara ◽  
Miyuki Nakatani ◽  
Kazunori Yamada ◽  
...  
Keyword(s):  
Shear Wave ◽  
Plantar Flexion ◽  
Joint Stiffness ◽  
Medial Gastrocnemius ◽  
Neutral Position ◽  
Acute Effects ◽  
Passive Joint ◽  
Significant Difference ◽  
The Right ◽  
Passive Muscle

The aim of the present study was to examine the acute effects of dermal suction on the passive mechanical properties of specific muscles and joints. Dermal suction was applied to the calves of 24 subjects. Passive plantar flexion torque was measured with the right knee fully extended and the right ankle positioned at 20°, 10°, 0°, and −10° angles, where 0° represents the ankle neutral position, and positive values correspond to the plantar flexion angle. The shear wave velocity (SWV) (m/s) of the medial gastrocnemius was measured in the same position using ultrasound shear wave elastography. The relationship between the joint angle and passive torque at each 10° angle was defined as passive joint stiffness (Nm/°). Passive muscle and joint stiffness were measured immediately before and after the dermal suction protocol. When the ankle joint was positioned at 20° (r = 0.53, P = 0.006), 10° (r = 0.43, P = 0.030), and −10° (r = 0.60, P = 0.001), the SWV was significantly higher after dermal suction than that before dermal suction. Regarding joint stiffness, we found no significant difference between the pre- and post-dermal suction values (partial η2 = 0.093, P > 0.05). These findings suggest that dermal suction increases passive muscle stiffness and has a limited impact on passive joint stiffness.

Complications of Supine Surgical Achilles Tendon Repair

2018 ◽  
Vol 39 (6) ◽  
pp. 720-724 ◽  
Author(s):  
John J. Marcel ◽  
Katherine Sage ◽  
Gregory P. Guyton
Keyword(s):  
Achilles Tendon ◽  
Supine Position ◽  
Primary Repair ◽  
Tendon Repair ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Achilles Tendon Repair ◽  
Concomitant Surgery ◽  
Tendon Surgery

Background: Open Achilles tendon surgery with the patient in the supine position potentially avoids the complications of the prone position, but the safety and viability of the supine position for this procedure are not known. The aim of this study was to test the hypothesis that supine positioning for open repair of acute Achilles tendon ruptures would be safe, with low wound and neurologic complication rates. Methods: Supine position safety in acute Achilles tendon repair was investigated. Consecutive cases of supine Achilles tendon surgical repair performed by one surgeon from 2010 to 2015 were retrospectively reviewed. Patients were included if they were surgically treated with primary repair in the supine position within 15 days of injury and did not undergo concomitant surgery. A paramedian incision 1 cm medial to the Achilles sheath was used. Initial chart review identified 161 patients who underwent any type of Achilles tendon surgery in the supine position, of whom 45 patients met the inclusion criteria. This group included 39 men and 6 women with an average age of 41 years (range, 20–66 years). Median length of follow-up was 116 days (range, 25–1,589 days). Average body mass index was 29 kg/m2 (range, 23–36 kg/m2). Results: There were no infections, sural nerve injuries, or reruptures. Conclusions: The supine position was safe for primary open Achilles tendon repair, with no wound or neurologic complications. Level of Evidence: Level IV, case series.

scholarly journals Twelve-years’ experience in minimal invasive Achilles tendon repair using a suture-guiding device

2019 ◽  
Vol 26 (2) ◽  
pp. 89-94
Author(s):  
Prisca Yeung ◽  
Lok Pong Man ◽  
Wing Hang Angela Ho
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Operating Time ◽  
Tendon Repair ◽  
Minimal Invasive ◽  
Achilles Tendon Repair ◽  
Invasive Method ◽  
The Mean

Introduction: Minimal invasive Achilles tendon repair is becoming more and more popular recently. We have evaluated our results in Achilles tendon repair using minimally invasive method by a suture-guiding device. Methods: This is a retrospective review of patients with acute Achilles tendon rupture, which was repaired using minimally invasive method namely the suture-guiding device, that was performed during 2003 to 2015 in our department. Outcome parameters were the incidence of re-rupture, other complications, and the functional outcome. Results: There were 36 men (90%) and 4 women (10%) in this study. Mechanisms of injury were basketball (28%), football (15%), squash (15%), and trauma (13%). The mean operating time was 59 min (range 30–90 min). The mean follow-up time was 8 months (range 3–35 months). The mean duration with casting was 7 weeks. The mean range of movement at 3 months was 8° dorsiflexion and 33° plantar flexion. There was no major complication necessitating surgical re-interventions such as re-ruptures and infections. No patient suffered from dysfunction of the sural nerve or delay wound healing. Conclusion: Minimally invasive Achilles tendon repair using suture-guiding device is a safe and quick procedure with a low rate of re-rupture and a satisfactory short-term and long-term recovery. Level of evidence: IV.

scholarly journals Passive stiffness of the ankle and plantar flexor muscle performance after Achilles tendon repair: a cross-sectional study

2017 ◽  
Vol 21 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Pollyana R.T. Borges ◽  
Thiago R.T. Santos ◽  
Paula R.S. Procópio ◽  
Jessica H.D. Chelidonopoulos ◽  
Roberto Zambelli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Repair ◽  
Cross Sectional Study ◽  
Muscle Performance ◽  
Plantar Flexor ◽  
Passive Stiffness ◽  
Sectional Study ◽  
Flexor Muscle ◽  
Cross Sectional ◽  
Achilles Tendon Repair

scholarly journals Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Malachy P. McHugh ◽  
Karl F. Orishimo ◽  
Ian J. Kremenic ◽  
Julia Adelman ◽  
Stephen J. Nicholas
Keyword(s):  
Achilles Tendon ◽  
Muscle Fiber ◽  
Fourier Transforms ◽  
Plantar Flexion ◽  
Maximum Voluntary Contraction ◽  
Tendon Repair ◽  
Voluntary Contraction ◽  
Plantar Flexor ◽  
Achilles Tendon Repair ◽  
Tendon Elongation

Objectives: It has been proposed that increased tendon elongation after Achilles tendon repair contributes to selective weakness in end-range plantar flexion (Mullaney et al 2006). Excessive tendon elongation during maximum voluntary contraction (MVC) means greater muscle fiber shortening. Since mean frequency (MF) of the electromyogram (EMG) increases with muscle fiber shortening, it was hypothesized that during isometric plantar flexor MVCs MF would be higher on the involved versus non-involved side. Therefore, the purpose of this study was to examine MF during isometric MVCs in patients with Achilles tendon repairs. Methods: Maximum isometric plantar flexion torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantar flexion in 17 patients (mean±SD age, 39±9 years; 15 men, 2 women) 43±24 months after surgery (range, 9 months to 8 years). Surface EMG signals were recorded during strength tests. MF was calculated from Fast Fourier Transforms of medial gastroc (MG) lateral gastroc (LG) and soleus (S) EMG signals. Effect of weakness on MF was assessed using analysis of variance. Based on reported plantar flexor MF values it was estimated that with 17 subjects there would be 80% power to detect a 16% difference in MF between involved and noninvolved legs at P<0.05. Results: Patients had marked weakness in 20° plantar flexion (deficit 28±18%, P<0.01; 14 of 17 deficit >20%) but no significant weakness in 20° dorsiflexion (deficit 8±15%, P=0.20; 4 of 17 deficit >20%). MF increased moving from dorsiflexion to plantar flexion (P<0.001) but overall was not different between involved and noninvolved sides (P=0.22). However, differences in MF between the involved and noninvolved sides were apparent in the patients with marked weakness. At 10° plantar flexion 8 of 17 patients had marked weakness (>20% deficit). MF at 10° plantar flexion was significantly higher on involved versus noninvolved side in patients with weakness but this was not apparent in patients with no weakness (side by group P=0.014; Table 1). MF at 10° plantar flexion average across the 3 muscles was 13% higher on the involved versus noninvolved side in patients with weakness (P=0.012) versus 3% lower in patients with no weakness (P=0.47). Conclusion: Higher MF on the involved versus noninvolved side in patients with significant plantar flexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily due to excessive lengthening of the repaired Achilles tendon. If weakness were simply due to atrophy, a lower MF would have been be expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantar flexion after Achilles repair. [Table: see text]

Weakness in End-Range Plantar Flexion after Achilles Tendon Repair

2006 ◽  
Vol 34 (7) ◽  
pp. 1120-1125 ◽  
Author(s):  
Michael J. Mullaney ◽  
Malachy P. McHugh ◽  
Timothy F. Tyler ◽  
Stephen J. Nicholas ◽  
Steven J. Lee
Keyword(s):  
Achilles Tendon ◽  
Plantar Flexion ◽  
Tendon Repair ◽  
Achilles Tendon Repair
Sign in / Sign up

Export Citation Format

Share Document