Total rupture of achilles tendon induces inflammatory response and glial activation on the mice spinal cord

Abstract Rupture of Achilles tendon is a common accident affecting professional and recreational athletes. Acute and chronic pains are symptoms commonly observed in ruptured patients. Despite that, no studies have described whether Achilles tendon rupture is able to promote disorders in CNS. Based in these finds, the current study aimed to evaluate nociceptive alterations and inflammatory response in L5 lumbar segment of Balb/c mice spinal cord after Achilles tendon rupture. We demonstrated increased algesic response in the paw of ruptured group on the 7th and 14th days post tenotomy when compared with control group. This phenomenon was accompanied by over expression of COX-2 and NOS-2 as well as hyperactivation of astrocytes and microglia in nociceptive areas of L5 spinal cord as evidenced by intense GFAP and IBA-1 immunostaining, respectively. Biochemical studies also demonstrated increased levels of nitrite in the L5 spinal cord of tenotomized animals when compared with control group. Thus, we have demonstrate for the first time that total rupture of the Achilles tendon induces inflammatory response, nitrergic and glial activation in the CNS at L5 spinal cord region.

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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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Minimally invasive repair of ruptured Achilles tendon

Acta chirurgica iugoslavica ◽

10.2298/aci1501085b ◽

2015 ◽

Vol 62 (1) ◽

pp. 85-88

Author(s):

Nikola Bulatovic ◽

Miroslav Kezunovic ◽

Zarko Dasic ◽

Nikola Fatic

Keyword(s):

Surgical Technique ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Functional Results ◽

Recreational Athletes ◽

Acute Injuries ◽

Clinical Center ◽

Immobility Time ◽

Heel Bone

INTRODUCTION: Achilles tendon rupture usually occurs in recreational athletes of middle age 30-50godina and typical place of the rupture of 3-5 cm above the insertion of the heel bone. Most common in recreational athletes. OBJECTIVE: To view the surgical technique suture the tendon with a guide ?Achillon? the functional outcome of acute injuries. MATERIAL AND METHODS: retrospective analysis included a total of 20 patients treated at the Clinic of Orthopedics and Traumatology, Clinical Center of Montenegro in Podgorica in the 2009-14. They were monitored for 12 months. Diagnosis is based on history, clinical examination Thompson?s Simmond O?Brien test, ECHO and NMR. RESULTS: The average age was 38.8 ?2.79 years 21-52 years. Right in 14 respondents 70%, the left side in 6 30%. There were no complications as: infection, thrombosis, rerupture and embolism. Functional results tables we have shown through specific scores. CONCLUSION: It can be concluded that this procedure provides a simple and quick surgical technique, a small percentage of complications, shorter immobility time and good functional results.

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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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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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Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith Versus Tenolig

Medicina ◽

10.3390/medicina57101073 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1073

Author(s):

Carlo Biz ◽

Mariachiara Cerchiaro ◽

Elisa Belluzzi ◽

Nicola Luigi Bragazzi ◽

Giacomo De Guttry ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Return To Sport ◽

Functional Results ◽

Return To Sports ◽

Recreational Athletes ◽

Sport Activities ◽

Long Term Follow Up

Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical–functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical–functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle–Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical–functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120966041 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096604

Author(s):

Lafi S. Khalil ◽

Toufic R. Jildeh ◽

Joseph S. Tramer ◽

Muhammad J. Abbas ◽

Luke Hessburg ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Demographic Characteristics ◽

National Basketball Association ◽

Control Group ◽

Tendon Ruptures ◽

And Performance ◽

Player Performance

Background: National Basketball Association (NBA) players who return to sport (RTS) after Achilles tendon rupture have been reported to have poor outcomes. Purpose: To evaluate the effect of Achilles tendon ruptures on player performance and career longevity in NBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: NBA players who sustained Achilles tendon ruptures between 1970 and 2019 were identified using publicly available resources and were matched 1:1 to a healthy control group by age, position, height, and body mass index. Demographic characteristics, player utilization (games and minutes), and performance efficiency rating (PER) were documented for all athletes. The season of Achilles tendon rupture was set as the index year, and statistical analysis compared postindex versus preindex data both acutely and in the long term. Percentages relative to preoperative values were calculated to compare the injured and control groups in a standardized fashion. Results: Of 47 players, 34 (72.3%) with Achilles tendon ruptures returned to play at the NBA level after surgical intervention. A total of 7 players were excluded from the study. No differences were found in demographic characteristics or PER (2 years before injury) between the remaining 27 players and matched controls. The injured players had significantly shorter careers compared with control players (3.1 ± 2.3 vs 5.8 ± 3.5 seasons, respectively; P < .05). Injured players demonstrated significant declines in games per season (GPS), minutes per game (MPG), and PER at 1 year and 3 years after RTS compared with preindex baseline ( P < .05). Injured players, compared with control players, had reduced relative percentages of games started (GS) (50% vs 125%, respectively), MPG (83% vs 103%), and PER (80% vs 96%) at 1 year after return ( P < .05), but reductions at extended 3-year follow-up were seen only in GPS (71% vs 91%) and GS (39% vs 99%) ( P < .05). Conclusion: Our study found that 72.3% of NBA players returned to play after Achilles tendon repair, but they had shorter careers compared with uninjured controls. Players returning from Achilles tendon repairs had decreased game utilization and performance at all time points relative to their individual preindex baseline. However, for the injured players when compared with controls, game utilization but not performance was found to be decreased at 3-year follow-up.

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Does Early Functional Mobilization Affect Long-Term Outcomes After an Achilles Tendon Rupture? A Randomized Clinical Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120906522 ◽

2020 ◽

Vol 8 (3) ◽

pp. 232596712090652 ◽

Cited By ~ 4

Author(s):

Susanna Aufwerber ◽

Annette Heijne ◽

Gunnar Edman ◽

Karin Grävare Silbernagel ◽

Paul W. Ackermann

Keyword(s):

Achilles Tendon ◽

General Health ◽

Tendon Rupture ◽

Standard Treatment ◽

Negative Impact ◽

Controlled Trial ◽

Achilles Tendon Rupture ◽

Control Group ◽

Ankle Motion ◽

Patient Reported

Background: Functional deficits and health-related impairments are common after an Achilles tendon rupture (ATR). Rehabilitation protocols vary greatly, and few studies have allowed loading in combination with ankle motion immediately after surgery (ie, early functional mobilization [EFM]). It is unclear whether EFM may counteract the negative impact of ankle immobilization after an ATR. Purpose: The primary aim of this study was to assess the efficacy of EFM compared with standard treatment (ie, 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis) regarding patient-reported and functional outcomes in patients with an ATR after acute operative repair. The secondary aim was to explore whether the occurrence of deep venous thrombosis (DVT) during the 2 postoperative treatments affected outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 135 patients who underwent ATR repair, randomized to either EFM, including immediate postoperative loading and ankle motion, or standard treatment, were evaluated with functional tests and 5 self-administered outcome questionnaires at 6 and 12 months postoperatively. Results: At 6 months, the EFM group scored higher on the RAND 36-Item Health Survey (RAND-36) questionnaire subscales of general health and vitality ( P < .05) compared with the control group. No significant differences between the groups were found on disease-specific questionnaires (Achilles tendon Total Rupture Score [ATRS] and Foot and Ankle Outcome Score [FAOS]). At 12 months, no significant differences on any of the patient-reported outcome measures or the functional heel-rise test were seen between the groups. The RAND-36 subscale of general health, however, exhibited higher values in the EFM group (82.6 ± 16.9) than the control group (77.1 ± 17.0) ( P = .051) at 12 months after the injury. Patients sustaining DVT postoperatively had lower self-reported outcomes on the ATRS, FAOS, and RAND-36 questionnaires at 6 and 12 months compared with patients not having sustained DVT (all P < .05). Conclusion: This study demonstrated that an accelerated postoperative protocol with immediate loading and ankle motion resulted in better general health and vitality at 6 months. However, there were no differences between the groups in the recovery of heel-rise function. Future studies should focus on the means to reduce the risk of DVT to improve patient outcomes after ATR. Registration: NCT02318472 (ClinicalTrials.gov identifier).

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000257 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Moses Lee ◽

Jin Soo Suh ◽

Myung Jin Shin

Keyword(s):

Surgical Treatment ◽

Prognostic Factor ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Defect Size ◽

Control Group ◽

Study Group ◽

Factors Affecting ◽

Rupture Site

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

Foot & Ankle International ◽

10.1177/107110079701800605 ◽

1997 ◽

Vol 18 (6) ◽

pp. 339-341 ◽

Cited By ~ 11

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.

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Individualized treatment for acute Achilles tendon rupture based on the Copenhagen Achilles Rupture Treatment Algorithm (CARTA): a study protocol for a multicenter randomized controlled trial

10.21203/rs.3.rs-19305/v2 ◽

2020 ◽

Author(s):

Maria Swennergren Hansen ◽

Marianne Toft Vestermark ◽

Per Hölmich ◽

Morten Tange Kristensen ◽

Kristoffer Weisskirchner Barfod

Keyword(s):

Randomized Controlled Trial ◽

Achilles Tendon ◽

Tendon Rupture ◽

Controlled Trial ◽

Achilles Tendon Rupture ◽

Treatment Algorithm ◽

Intervention Group ◽

Individualized Treatment ◽

Control Group ◽

Randomized Controlled

Abstract Background: An individualized treatment algorithm (Copenhagen Achilles Rupture Treatment Algorithm - CARTA) based on the ultrasonographic appearance of an acute Achilles tendon rupture has been developed aiming to select the correct patients for operative and non-operative treatment. The objective of this study is to investigate if this individualized treatment algorithm gives a better functional outcome than treating all patients either operatively or non-operatively per default. Methods: This study is conducted as a multicenter three-armed randomized controlled trial. Participants are included from four hospitals in Denmark and randomized 1:1:1 to one of three parallel groups: 1) Intervention group: Participants are treated according to an individualized treatment algorithm, 2) Control group A: Participants are treated non-operative, 3) Control group B: Participants are treated operative. The individualized treatment algorithm for the intervention group is based on an ultrasonographic examination; tendon overlap and elongation below 7% is to be treated non-operative, while no tendon overlap and and/or elongation above 7% will be treated operative. 300 participants will be included over a period of 3 years. The primary outcome is the heel-rise work test at 12 months post-injury. Secondary outcomes are tendon elongation, the Achilles tendon Total Rupture Score (ATRS), the rate of re-ruptures and other complications. The primary analysis will be conducted as intention-to-treat analysis.Discussion: This trial will indicate if treatment of acute Achilles tendon rupture can be individualized based on the elongation and tendon overlap. It is hypothesized that different patients will benefit from different treatment instead of offering all the same treatment. Trial registration: ClinicalTrials.gov Identifier: NCT03525964. Registered 16 May 2018.

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