Int J Sports Med 2012; 33(06): 474-479
DOI: 10.1055/s-0032-1301932
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Deficits 10-Years after Achilles Tendon Repair

T. Horstmann
1   Faculty for Sport and Health Sciences, Technische Universität München, Germany
,
C. Lukas
2   MEDICAL PARK Bad Wiessee St. Hubertus, Bad Wiessee, Germany
,
J. Merk
3   Orthopedics, Center for Rehabilitation HESS, Bietigheim-Bissingen, Germany
,
T. Brauner
4   Physiotherapy, BG Unfallklinik Tübingen, Germany
,
A. Mündermann
5   Sport Science, Universität Konstanz, Germany
› Author Affiliations
Further Information

Publication History



accepted after revision 12 January 2012

Publication Date:
12 April 2012 (online)

Abstract

The purpose of this study was to determine the long-term impact of surgical repair and subsequent 6-week immobilization of an Achilles tendon rupture on muscle strength, muscle strength endurance and muscle activity. 63 patients participated in this study on average 10.8±3.4 years after surgically repaired Achilles tendon rupture and short-term immobilization. Clinical function was assessed and muscle strength, strength endurance and muscle activity were measured using a dynamometer and electromyography. Ankle ROM, heel height during heel-raise tests and calf circumference were smaller on the injured than on the contralateral side. Ankle torques during the concentric dorsiflexion tasks at 60°/sec and 180°/sec and ankle torques during the eccentric plantarflexion task and during the concentric plantarflexion task at 60°/sec for the injured leg were significantly lower than those for the contralateral leg. The total work during a plantarflexion exercise at 180°/sec was 14.9% lower in the injured compared to the contralateral leg (p<0.001). Muscle activity for the gastrocnemius muscle during dorsiflexion tasks was significantly higher in the injured than in the contralateral limb. Limited ankle joint ROM and increased muscle activity in the injured leg suggest compensatory mechanisms to account for differences in muscle morphology and physiology caused by the injury.

 
  • References

  • 1 Aktas S, Kocaoglu B. Open versus minimal invasive repair with Achillon device. Foot Ankle Int 2009; 30: 391-397
  • 2 Ames PR, Longo UG, Denaro V, Maffulli N. Achilles tendon problems: not just an orthopaedic issue. Disabil Rehabil 2008; 30: 1646-1650
  • 3 Bamman MM, Newcomer BR, Larson-Meyer DE, Weinsier RL, Hunter GR. Evaluation of the strength-size relationship in vivo using various muscle size indices. Med Sci Sports Exerc 2000; 32: 1307-1313
  • 4 Don R, Ranavolo A, Cacchio A, Serrao M, Costabile F, Iachelli M, Camerota F, Frascarelli M, Santilli V. Relationship between recovery of calf-muscle biomechanical properties and gait pattern following surgery for Achilles tendon rupture. Clin Biomech (Bristol, Avon) 2007; 22: 211-220
  • 5 Häggmark T, Eriksson E. Hypotrophy of the soleus muscle in man after Achilles tendon rupture. Discussion of findings obtained by computed tomography and morphologic studies. Am J Sports Med 1979; 7: 121-126
  • 6 Häggmark T, Liedberg H, Eriksson E, Wredmark T. Calf muscle atrophy and muscle function after non-operative vs operative treatment of Achilles tendon ruptures. Orthopedics 1986; 9: 160-164
  • 7 Harriss DJ, Atkinson G. Update – Ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
  • 8 Horstmann GA, Gollhofer A, Dietz V. Reproducibility and adaptation of the EMG responses of the lower leg following perturbations of upright stance. Electroencephalogr Clin Neurophysiol 1988; 70: 447-452
  • 9 Horstmann T, Maschmann J, Mayer F, Heitkamp HC, Handel M, Dickhuth HH. The influence of age on isokinetic torque of the upper and lower leg musculature in sedentary men. Int J Sports Med 1999; 20: 362-367
  • 10 Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin 2005; 10: 255-266
  • 11 Kadaba MP, Ramakrishnan HK, Wootten ME, Gainey J, Gorton G, Cochran GV. Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait. J Orthop Res 1989; 7: 849-860
  • 12 Kangas J, Pajala A, Siira P, Hamalainen M, Leppilahti J. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 2003; 54: 1171-1180; discussion 1180–1171
  • 13 Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 2005; 87: 2202-2210
  • 14 Leppilahti J, Siira P, Vanharanta H, Orava S. Isokinetic evaluation of calf muscle performance after Achilles rupture repair. Int J Sports Med 1996; 17: 619-623
  • 15 Leveau B, Andersson GBJ. Output forms: Data analysis and applications. Interpretation of the electromyographic signal. In: Soderberg GL. ed. Selected Topics in Surface Electromyography for Use in Occupational Settings: Expert Perspectives. Washington DC: U.S. Department of Health and Human Services; 1992: 70-102
  • 16 Lill H, Moor C, Schmidt A, Echtermeyer V. Current status of treatment of Achilles tendon ruptures. Results of a nationwide survey in Germany. Chirurg 1996; 67: 1160-1165
  • 17 Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med 2003; 31: 692-700
  • 18 Maffulli N, Waterston SW, Squair J, Reaper J, Douglas A. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med 1999; 9: 157-160
  • 19 Magnus CR, Barss TS, Lanovaz JL, Farthing JP. Effects of cross-education on the muscle after a period of unilateral limb immobilization using a shoulder sling and swathe. J Appl Physiol 2010; 109: 1887-1894
  • 20 Majewski M, Schaeren S, Kohlhaas U, Ochsner PE. Postoperative rehabilitation after percutaneous Achilles tendon repair: early functional therapy versus cast immobilization. Disabil Rehabil 2008; 30: 1726-1732
  • 21 Moller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand 1996; 67: 479-481
  • 22 Moller M, Lind K, Movin T, Karlsson J. Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment. Scand J Med Sci Sports 2002; 12: 9-16
  • 23 Naim F, Simsek A, Sipahioglu S, Esen E, Cakmak G. Evaluation of the surgical results of Achilles tendon ruptures by gait analysis and isokinetic muscle strength measurements. Acta Orthop Traumatol Turc 2005; 39: 1-6
  • 24 Neumann D, Vogt L, Banzer W, Schreiber U. Kinematic and neuromuscular changes of the gait pattern after Achilles tendon rupture. Foot Ankle Int 1997; 18: 339-341
  • 25 Nilsson-Helander K, Silbernagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, Karlsson J. Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 2010; 38: 2186-2193
  • 26 Olsson N, Nilsson-Helander K, Karlsson J, Eriksson BI, Thomee R, Faxen E, Silbernagel KG. Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1385-1393
  • 27 Quagliarella L, Sasanelli N, Notarnicola A, Belgiovine G, Moretti L, Moretti B. Comparative functional analysis of two different Achilles tendon surgical repairs. Foot Ankle Int 2010; 31: 306-315
  • 28 Rippstein PF, Jung M, Assal M. Surgical repair of acute Achilles tendon rupture using a “mini-open” technique. Foot Ankle Clin 2002; 7: 611-619
  • 29 Speck M, Klaue K. Early full weightbearing and functional treatment after surgical repair of acute Achilles tendon rupture. Am J Sports Med 1998; 26: 789-793
  • 30 Suchak AA, Bostick GP, Beaupre LA, Durand DC, Jomha NM. The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am 2008; 90: 1876-1883
  • 31 Veldhuizen JW, Verstappen FT, Vroemen JP, Kuipers H, Greep JM. Functional and morphological adaptations following four weeks of knee immobilization. Int J Sports Med 1993; 14: 283-287
  • 32 Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 2010; 92: 2767-2775
  • 33 Winter E, Ambacher T, Maurer F, Weller S. Surgical therapy of Achilles tendon rupture. Unfallchirurg 1995; 98: 468-473