Muscular and Tendon Degeneration after Achilles Rupture: New Insights into Future Repair Strategies

Achilles tendon rupture is a frequent injury with an increasing incidence. After clinical surgical repair, aimed at suturing the tendon stumps back into their original position, the repaired Achilles tendon is often plastically deformed and mechanically less strong than the pre-injured tissue, with muscle fatty degeneration contributing to function loss. Despite clinical outcomes, pre-clinical research has mainly focused on tendon structural repair, with a lack of knowledge regarding injury progression from tendon to muscle and its consequences on muscle degenerative/regenerative processes and function. Here, we characterize the morphological changes in the tendon, the myotendinous junction and muscle belly in a mouse model of Achilles tendon complete rupture, finding cellular and fatty infiltration, fibrotic tissue accumulation, muscle stem cell decline and collagen fiber disorganization. We use novel imaging technologies to accurately relate structural alterations in tendon fibers to pathological changes, which further explain the loss of muscle mechanical function after tendon rupture. The treatment of tendon injuries remains a challenge for orthopedics. Thus, the main goal of this study is to bridge the gap between clinicians’ knowledge and research to address the underlying pathophysiology of ruptured Achilles tendon and its consequences in the gastrocnemius. Such studies are necessary if current practices in regenerative medicine for Achilles tendon ruptures are to be improved.

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The ultrasonographic dynamic heel-rise test of the Achilles tendon

Journal of Ultrasonography ◽

10.15557/jou.2021.0043 ◽

2021 ◽

Vol 21 (86) ◽

pp. e260-e266

Author(s):

Beata Ciszkowska-Łysoń ◽

◽

Urszula Zdanowicz ◽

Robert Śmigielski ◽

◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Dynamic Assessment ◽

Healing Process ◽

Achilles Tendon Rupture ◽

Recovery Process ◽

Biomechanical Properties ◽

Resonance Imaging ◽

Ultrasound Monitoring ◽

And Function

The treatment of Achilles tendon rupture attempts to restore the primary anatomical structure and principal biomechanical properties of the damaged tendon. Postoperative clinical assessment of the healing progression and function monitoring may be difficult and require experience. Diagnostic imaging (ultrasonography and magnetic resonance imaging) helps monitor the healing process. In the following paper, we propose a heel-rise test – a dynamic assessment of the Achilles tendon performed under direct observation and ultrasound monitoring to establish the tension of the Achilles tendon. The test allows for a simple assessment of tendon function and may be safely repeated at any postoperative stage. It may be performed by a physician, radiologist and physiotherapist to monitor the recovery process following Achilles tendon damage.

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Division Tenorrhaphy: A Novel Technique for Chronic or Failed Nonoperatively Treated Achilles Tendon Rupture

Foot & Ankle Specialist ◽

10.1177/1938640016685145 ◽

2017 ◽

Vol 10 (3) ◽

pp. 242-245

Author(s):

Jesse Doty ◽

Yoshihiro Katsuura ◽

Nicholas Richardson

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

High Strength ◽

Nonoperative Treatment ◽

Poor Quality ◽

Myotendinous Junction ◽

Foot And Ankle ◽

Open Technique ◽

American Orthopaedic

Here we describe a modified open technique for the repair of a ruptured Achilles tendon using multiple looped sutures with the creation of interdigitating tendon stumps maximizing surface area for suture application as well as allowing for significant tissue overlay. This technique produces a high strength repair that is useful in cases of extensive degeneration or poor-quality tissue. Degenerative tissue may be encountered with chronic ruptures or failed nonoperative treatment, as well as those ruptures that occur at the proximal myotendinous junction. We present 2 cases in which the technique was utilized: one of a failed nonoperatively treated rupture and another of a chronic rupture. The technique was found to be successful for both patients with improvement in visual analogue scale, Achilles tendon total rupture score, American Orthopaedic Foot and Ankle Score, and Foot and Ankle Disability Index. Levels of Evidence: Level IV

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Morphological and Functional Outcomes >13 Years After Achilles Tendon Rupture Treated Operatively and Non-operatively

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00511 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0051

Author(s):

Kevin Willits ◽

Trevor Birmingham ◽

Alison Spouge ◽

Dianne Bryant ◽

Michaela Khan

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Morphological Changes ◽

Vertical Jump ◽

Achilles Tendon Rupture ◽

Jump Height ◽

Vertical Jump Height ◽

Functional Measures ◽

Superior Margin

Objectives: In patients >13yrs after treatment for acute Achilles tendon rupture (AATR), 1) investigate side-to-side differences in MRI-defined morphological changes in the Achilles tendon and surrounding calf musculature, 2) investigate side-to-side differences in single-limb functional tasks, and 3) compare patients who received operative vs non-operative treatment. Methods: 28 patients (11 operative, 17 non-operative) from a previous randomized trial returned 15±1 years post-AATR for testing (age: 57±7 years; BMI: 30±5 kg/m2). Patients underwent bilateral 3T MRI (MAGNETOM Prisma, Siemens) including sagittal and axial T1 and T2-weighted turbo spin echo (TSE), axial T1-weighted inversion recovery, and sagittal T2-weighted 3D isotropic TSE sequences. The maximum anteroposterior Achilles tendon diameter (MAD) and cross-sectional area (CSA), distance from the MAD to the superior margin of the calcaneus, tendon length, gastrocnemius and soleus CSA, and calf circumference were measured using distance and area software tools (Figure 1; AGFA Healthcare). Functional measures included single-legged heel-rise repetitions and maximum vertical jump height. All outcomes were compared between limbs and between groups. Results: Overall, there were significant side-to-side differences in most MRI and functional measures, with the injured limb Achilles tendon typically wider and thicker (MAD often twice as large), calf musculature CSA smaller, number of heel raises lower, and vertical jump height lower (Table 1). The only differences between treatment groups was in MAD and the distance from the MAD to the superior margin of the calcaneus, with a greater side-to-side difference for patients treated operatively (Table 1). Conclusion: Substantial side-to-side differences in tendon diameter, thickness, muscle bulk and functional performance persist beyond a decade after treatment for AATR. There were no differences favoring operative treatment over non-operative treatment.

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