Abstract
BackgroundDuring management of Achilles tendon rupture, determination of tendon-end approximation, either clinically or by ultrasound is difficult, following brace application of during loading.The Radiographic Achilles Tendon Loading Angle (RadATLA) is proposed as a method of measuring ankle position whilst loading in a brace during the management of Achilles tendon rupture. This study aims to determine the reliability and reproducibility of the RadATLA. MethodsA loaded true lateral ankle radiograph including the fifth metatarsal head was taken when wearing a brace at the 6-week time point in 18 patients (19 ankles). following Achilles tendon repair or reconstruction. The RadATLA was compared with the Tibio-talar angle, other radiographic and clinical measures used to quantify foot and ankle position during the first 6 weeks of early rehabilitation in a resting position and during loading. ResultsThe intra-rater reliability of both angles was found to be good (>0.8). The RadATLA was found to have an excellent intra-rater reliability with Intra-class correlation of (ICC) 0.992−0.996 (95%CI 0.889−0.999), standard error of the measurement (SEM) 1.03–3.65 and Minimal Detectable Change (MDC) 2.86−10.12. The inter-rater reliability was good with ICC of 0.798−0.969 (95%CI−0.03 to 0.964), SEM 2.9–7.6, and MDC 8.1–20.9.The RadATLA loaded at 6 weeks in all patients was at mean (SD) (range) 41.9˚ (16.5), (18.5−75.9). There was a significant difference between the patients in the Repair group compared with patients in the Reconstruction group both in RadATLA loaded at 6 weeks: 35.6˚ (11.2), (18.5−56.5) versus 55.5˚ (19), (20−75.9), (p = 0.01). The amount loaded in all patients was at mean (SD) (range) 29.2Kg (17.7), (2−56) and the percentage Body Weight was 30.7% (19), (2.1−63.2). There were no differences between the groups neither in amount loaded nor in percentage Body weight (p = 0.614−0.651). ConclusionsThe RadATLA is a reliable and reproducible angle and can be used to determine the position of the ankle, when loaded in a brace during rehabilitation following Achilles tendon rupture.
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