Abstract
BackgroundAchilles tendon rupture appears to alter stiffness and length of the tendon. These alterations may affect the function of tendon in force transmission and in energy storage and recovery. We studied the mechanical properties of the Achilles' tendon post-rupture and their association with function. MethodsTwenty-four (20 males, 4 females) participants (mean age: 43 y, 176 cm, 81 kg) were recruited. Ultrasonography and dynamometry were used to assess the muscle-tendon unit morphological and mechanical properties of non-surgically treated patients 1-year post rupture. FindingsInjured tendons were longer with difference of 1.8 cm (95%CI: 0.5–1.9 cm; P < 0.001), and thicker by 0.2 mm (0.2–0.3 mm; P < 0.01). Medial gastrocnemius cross-sectional area was 1.0 cm2 smaller (0.8–1.1 cm2; P < 0.001), fascicles were 0.6 cm shorter (0.5–0.7 cm; P < 0.001) and pennation angle was 2.5° higher (1.3–3.6°; P < 0.001) when compared to the uninjured limb. We found no differences between injured and uninjured tendon stiffness 1-year post-rupture (mean difference: 29.8 N/mm, −7.7–67.3 N/mm; P = 0.170). The injured tendon showed 1.8 mm (1.2–2.4 mm; P < 0.01) lower elongation during maximal voluntary isometric contractions. Patient-reported functional outcome was related to the tendon resting length (β = 0.68, r(10) = 4.079, P = 0.002). Inter-limb differences in the medial gastrocnemius fascicle length were related to inter-limb differences in maximum contractions (β = 1.17, r(14) = 2.808, P = 0.014). InterpretationLonger Achilles tendon resting length was associated with poorer self-evaluated functional outcome. Although the stiffness of non-surgically treated and uninjured tendons was similar 1-year post rupture, plantar flexion strength deficit was still present, possibly due to shorter medial gastrocnemius fascicle length.
Highlights
The incidence of Achilles tendon rupture (ATR) is rising [1]
We report normalised stiffness because AT elongation at a given force depends on the resting length of the tendon [27]
Muscle-tendon structural properties AT resting length was significantly longer in the injured compared to the uninjured limb with a mean difference (95%CI) of 1.8 cm (0.5-1.9 cm; P
Summary
The incidence of Achilles tendon rupture (ATR) is rising [1]. The recovery of ATR is a long process [2], muscle strength decrements persist for several years and seem to be permanent [3]. Non-surgical treatment of ATR is considered safe, assessing biomechanical recovery of the ruptured tendon is important [4,5,6,7]. We studied the mechanical properties of the Achilles’ tendon post-rupture and their association with function. Ultrasonography and dynamometry were used to assess the muscle-tendon unit morphological and mechanical properties of non-surgically treated patients 1-year post rupture. We found no differences between injured and uninjured tendon stiffness 1-year post-rupture (mean difference: 29.8 N/mm, -7.7–67.3 N/mm; P=0.170). Interpretation Longer Achilles tendon resting length was associated with poorer self-evaluated functional outcome. The stiffness of non-surgically treated and uninjured tendons was similar 1-year post rupture, plantar flexion strength deficit was still present, possibly due to shorter medial gastrocnemius fascicle length
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