Factors Affecting Early Single Heel Raise after Repair of Achilles Tendon Rupture

Category: Sports Introduction/Purpose: No physical exam or clinical test can clearly predict a final course of acute Achilles tendon rupture after surgical treatment. But, in recent studies, ability to perform single-heel-raise during the early postoperative period was considered as a significant prognostic factor. Therefore, analysis of the relationship between preoperative factors and timing of the single heel raise might help to predict the prognosis and aid to establish an individualized rehabilitation plan. The purpose of this study was to analyze the factors affecting early single heel raise after surgical treatment of acute Achilles tendon rupture. Methods: From January 2012 to August 2015, a retrospective analysis was performed for 68 patients who met the inclusion criteria among 98 cases of surgically treated acute Achilles tendon rupture. Operative technique and rehabilitation protocol were same in all cases. The patients who were able to perform a single heel raise within 3 months postoperatively were classified into the study group and the rest was determined as the control group. During periodic outpatient observation, we evaluated Achilles tendon total rupture score (ATRS), Visual Analog Scale (VAS), and timing capable of a single heel raise. We also preoperatively measured defect size and distance between calcaneal osteotendinous junction and rupture site by ultrasound image in all cases. Results: No difference was found in demographic factors between the study group (23 cases) and the control group (45 cases) who performed a single heel raise later than 3 months postoperatively. There were no significant difference in defect size and distance between calcaneal osteotendinous junction to the rupture site (P=0.38, P=0.63). However, when the rupture site was divided into hyporvascular zone (from calcaneal osteotendinous junction to the rupture site: 4~7 cm) and hypervascular zone, the study group showed a significantly low hyporvascular zone rupture rate. (14/23, 41/45, P=0.003). Also, in the logistic regression analysis that included age, BMI, smoking, hyporvascular zone rupture, defect size, and operation delay, patients with hypervascular region rupture showed odds ratio of 5.3 (P=0.017) in performing a single heel raise within postoperative 3 month. ATRS score at postoperative 3 months and last f/u were significantly higher in the study group. (p<0.01) Conclusion: Achilles tendon rupture at hypovascular zone is a poor prognostic factor for the early single heel raise and might significantly affect the prognosis after acute Achilles tendon rupture operation.

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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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Patients with Achilles Tendon Rupture Have a Degenerated Contralateral Achilles Tendon: An Elastography Study

BioMed Research International ◽

10.1155/2018/2367615 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Qianru Li ◽

Qi Zhang ◽

Yehua Cai ◽

Yinghui Hua

Keyword(s):

Achilles Tendon ◽

Axial Strain ◽

Achilles Tendon Rupture ◽

Cross Sectional Area ◽

Control Group ◽

Computer Assisted ◽

Study Group ◽

Sectional Area ◽

Cross Sectional ◽

The Mean

Purpose. To evaluate differences of Achilles tendon (AT) hardness and morphology between asymptomatic tendons in patients with acute AT ruptures on the contralateral side and asymptomatic tendons in healthy people by using computer-assisted quantification on axial-strain sonoelastography (ASE). Methods. The study consisted of 33 asymptomatic tendons in 33 patients (study group) and 34 tendons in 19 healthy volunteers (control group). All the tendons were examined by both ASE and conventional ultrasound. Computer-assisted quantification on ASE was applied to extract hardness variables, including the mean (Hmean), 20th percentile (H20), median (H50) and skewness (Hsk) of the hardness within tendon, and the ratio of the mean hardness within tendon to that outside tendon (Hratio) and three morphological variables: the thickness (THK), cross-sectional area, and eccentricity (ECC) of tendons. Results. The Hmean, Hsk, H20, H50, and Hratio in the proximal third of the tendon body in study group were significantly smaller than those in control group (Hmean: 0.43±0.09 vs 0.50±0.07, p=0.001; Hsk: -0.53±0.51 vs -1.09±0.51, p<0.001; H20: 0.31±0.10 vs 0.40±0.10, p=0.001; H50: 0.45±0.10 vs 0.53±0.08, p<0.001; Hratio: 1.01±0.25 vs 1.20±0.23, p=0.003). The THK and cross-sectional area of tendons in the study group were larger than those in the control group (p<0.05). Conclusions. As a quantitative objective method, the computer-assisted ASE reveals that the asymptomatic ATs contralateral to acute rupture are softer than those of healthy control group at the proximal third and the asymptomatic tendons in people with rupture history are thicker, larger, and rounder than those of normal volunteers especially at the middle and distal thirds of AT body.

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Different Sutures in the Surgical Treatment of Acute Closed Achilles Tendon Rupture

Indian Journal of Surgery ◽

10.1007/s12262-014-1068-8 ◽

2014 ◽

Vol 77 (S3) ◽

pp. 936-940 ◽

Cited By ~ 2

Author(s):

Yunhan Ji ◽

Xin Ma ◽

Xu Wang ◽

Jiazhang Huang ◽

Chao Zhang ◽

...

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture

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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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Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198163030-00012 ◽

1981 ◽

Vol 63 (3) ◽

pp. 394-399 ◽

Cited By ~ 336

Author(s):

L Nistor

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Tendon Rupture ◽

Randomized Study ◽

Achilles Tendon Rupture ◽

Prospective Randomized Study ◽

Non Surgical Treatment

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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

The American Journal of Sports Medicine ◽

10.1177/0363546520956677 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3296-3305 ◽

Cited By ~ 1

Author(s):

Susanna Aufwerber ◽

Gunnar Edman ◽

Karin Grävare Silbernagel ◽

Paul W. Ackermann

Keyword(s):

Patient Outcome ◽

Cohort Study ◽

Achilles Tendon ◽

Muscle Atrophy ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Calf Muscle ◽

Control Group ◽

Tendon Elongation ◽

Over Time

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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