Abstract
PurposeThe primary aim of this study was to assess the relationship between the metabolites lactate and pyruvate in the healing tendon after Achilles tendon rupture (ATR) and patient-reported outcome at 6 and 12 months. A secondary aim was to evaluate which underlying factors regulate lactate and pyruvate concentrations.MethodsLactate and pyruvate concentrations were measured two weeks post-operatively in both the healing- and healthy Achilles tendon in 109 patients (90 men, 19 women; mean age 40 ± 7.9 years). Patient demographics, degree of physical activity, timing of surgery, operation time, patient-reported loading and step counts were investigated in relation to metabolite concentrations. At 6 and 12 months, the Achilles tendon Total Rupture Score (ATRS) questionnaire was used to assess patient outcome.ResultsThe mean number of steps taken during the post-operative days 1–10 was the only factor significantly related to the mean concentration of lactate (R2 = 0.34, p = 0.038), and pyruvate (R2 = 0.46, p = 0.006). Pyruvate was demonstrated as the only factor significantly associated with ATRS at both 6 months (R2 = 0.32, p = 0.003) and at 12 months (R2 = 0.37, p = 0.004) using multiple linear regression.ConclusionThe mean concentration of pyruvate during early ATR healing may predict patient outcome at 6 and 12 months post-operatively and possibly be used as a biomarker of healing. Early mobilization with an increased number of steps taken is an important clinical strategy to improve the metabolite concentrations during healing.Level of evidenceIII
Highlights
Tendon injuries are among the most common problems in athletes, causing long rehabilitation times and often lead to chronic problems with pain, weakness, impaired function and post-operative complication [1, 13, 18, 24, 26, 27]
At two weeks post-injury the mean concentrations of lactate and pyruvate were significantly increased in the healing tendons as compared to the contralateral uninjured Achilles tendons among the 109 included patients
The duration of the surgery, were significantly related to the concentrations of lactate or pyruvate that were assessed in the healing tendon at a mean of two weeks after Achilles tendon rupture (ATR) (Table 2)
Summary
Tendon injuries are among the most common problems in athletes, causing long rehabilitation times and often lead to chronic problems with pain, weakness, impaired function and post-operative complication [1, 13, 18, 24, 26, 27]. Achilles tendon rupture (ATR) has been shown to preclude the return to sports for approximately 20–30% of professional athletes [8]. ATR is associated with unpredictable and often poor long-term patient-reported outcomes [11, 29]. As of today there is no clear understanding of why the outcomes are so poor following ATR.
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