1
|
Shen C, Sun X, Li Z, Zhang R, Huang J, Tang K, Wang T, Xie Y, Chen L, Nie M. Panda Rope Bridge Technique promoted Achilles tendon regeneration in a novel rat tendon defect model. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39342498 DOI: 10.1002/ksa.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 09/10/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE This study aimed to determine whether the Achilles tendon tissue can undergo the pathological process of Achilles tendon regeneration after the Panda Rope Bridge Technique (PRBT). METHODS Rats (n = 120) that operated with Achilles tendon rupture were divided into three treatment groups: Defect group (D group), PRBT group and Defect + Fix group (DF group). The D group represented natural healing with no treatment, the PRBT group represented healing receiving PRBT treatment and the DF group represented healing through conservative treatment by ankle fixation. The morphological, histological and biomechanical properties of the defective Achilles tendon were assessed at 7, 10, 12, 14, 28 and 56 days postoperatively. RESULTS Compared to that observed in the other two groups, defected rat Achilles tendons that underwent PRBT recruited more cells earlier, eventually forming mature tendons, as revealed by histological analysis. PRBT also enabled defected tendons to regain stronger mechanical properties, thereby improving the prognosis. This improvement may be related to the earlier polarization of macrophages. CONCLUSION By establishing and using a novel surgical model of Achilles tendon rupture in rats, most injured Achilles tendons can regenerate and regain normal histological properties, whereas tendons with other interventions formed fibrotic scar tissue. The strong regenerative capacity of tendon tissue enabled us to describe the pathological process of tendon regeneration after PRBT surgery in detail, which would aid in the treatment of tendon injuries. PRBT promotes Achilles tendon regeneration and has the potential to become a standard treatment. LEVEL OF EVIDENCE Not applicable.
Collapse
Affiliation(s)
- Chen Shen
- Department of Orthopedic, Center for Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xianding Sun
- Department of Orthopedic, Center for Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi Li
- Department of Orthopedic, Center for Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruobin Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Junlan Huang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Kaiying Tang
- Department of Orthopedic, Center for Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Department of Orthopedic, Center for Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangli Xie
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Lin Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Mao Nie
- Department of Orthopedic, Center for Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Wendt M, Waszak M. Assessment of the stiffness of the upper trapezius muscle in a group of asymptomatic people with cervical spine rotation asymmetry. PLoS One 2024; 19:e0298544. [PMID: 38386652 PMCID: PMC10883562 DOI: 10.1371/journal.pone.0298544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
This study investigated the relationship between the stiffness of the upper trapezius muscle and the range of rotational movement of the cervical spine. A total of 60 right-handed asymptomatic students participated in the study. Participants (N = 22) characterised by asymmetry in rotational movements were selected for the experimental group. A difference of ≥10° between right and left rotation of the cervical spine was considered asymmetrical. The control group (N = 38) included participants whose rotation difference was < 10°. Belonging to the experimental or control group did not significantly differentiate trapezius muscle stiffness. The rotation side differentiated the stiffness of the right and left trapezius muscles only in the group of people with rotational movement asymmetry. There were high correlation coefficients between right cervical rotation and the stiffness of the muscle on the right side, and between rotation to the left and the stiffness of the muscle on the left side. There is a relationship between the stiffness of the right and left upper trapezius muscles and the range of right and left rotational motion of the cervical spine. Stiffness of the upper trapezius correlates more strongly with rotation to the side on which the muscle lies than to the opposite side. Increased stiffness of the upper trapezius muscle on the side of limited cervical spine rotation is likely to be determined by the muscle fibre stretching mechanism.
Collapse
Affiliation(s)
- Michał Wendt
- Department of Medical Biology, Poznan University of Physical Education, Poznań, Poland
| | - Małgorzata Waszak
- Department of Medical Biology, Poznan University of Physical Education, Poznań, Poland
| |
Collapse
|
3
|
Frederico RA, Santos TRT, Okai-Nóbrega LA, Ocarino JM, Souza TR, Fonseca ST. Runners with a history of shank and foot injury: Interactions among local musculoskeletal factors, age, and running experience. Phys Ther Sport 2023; 62:1-9. [PMID: 37300967 DOI: 10.1016/j.ptsp.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify subgroups of runners' profiles who had or did not have a History of Running-Related Injury in the Shank and Foot (HRRI-SF). DESIGN Cross-sectional. METHODS Clinical measures of passive ankle stiffness (measured as ankle position (compliance) to index passive joint stiffness), forefoot-shank alignment, peak torque of ankle plantar flexors, years of running experience, and age were analyzed through Classification and Regression Tree (CART). RESULTS The CART identified four subgroups of runners with a greater prevalence of HRRI-SF: (1) ankle stiffness ≤0.42°; (2) ankle stiffness >0.42°, age ≤23.5 years, and forefoot varus >19,64°; (3) ankle stiffness >0.42°, age >62.5 years, and forefoot varus ≤19.70°; (4) ankle stiffness >42°, age >62.5 years, forefoot varus >19.70°, and running experience ≤7 years. Three subgroups had a lower prevalence of HRRI-SF: (1) ankle stiffness >0.42° and age between 23.5 and 62.5 years; (2) ankle stiffness >0.42°, age ≤23.5 years, and forefoot varus ≤14.64°; (3) ankle stiffness >0.42°, age >62.5 years, forefoot varus >19.7°, and running experience >7 years. CONCLUSION One runner profile subgroup showed that higher ankle stiffness could predict HRRI-SF without association with other variables. Distinct interactions among variables characterized the other subgroups' profiles. The identified interactions among the predictors used to characterize the runners' profiles could be used in clinical decision-making.
Collapse
Affiliation(s)
- Renata Alves Frederico
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thiago Ribeiro Teles Santos
- Faculty of Physical Education and Physical Therapy, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Liria Akie Okai-Nóbrega
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Melo Ocarino
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thales Rezende Souza
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sergio Teixeira Fonseca
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
4
|
Riera J, Duclos NC, Néri T, Rambaud AJ. Is there any biomechanical justification to use hopping as a return to running test? A cross-sectional study. Phys Ther Sport 2023; 61:135-141. [PMID: 37030039 DOI: 10.1016/j.ptsp.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To assess the agreement and the correlation between asymmetry indexes of leg stiffness (AI(Kleg)) in running and hopping and the correlation between leg stiffness (Kleg) in running and hopping. DESIGN Cross-sectional study. SETTING Clinical facility. PARTICIPANTS Twelve healthy runners (5 women and 7 men; mean (SD) age = 36.6 (10.1) years; activity level = 6.4 (0.9) on Tegner scale). MAIN OUTCOME MEASURES A treadmill instrumented by photoelectric cells was used to collect data (flight and contact times) during running assessment (preferential and imposed velocity (3.33 m s-1) and during a hopping test. Kleg and AI(Kleg) were computed for each modality. Correlation tests were performed, and Bland Altman's plot was created. RESULTS A significant and large correlation was found between Kleg in hopping and running at imposed speed (r = 0.6, p = 0.001). An acceptable agreement was found between the AIs in hopping and running, with a bias of 0.04 (-0.15-0.06) at imposed speed and 0.03 (-0.13-0.07) at preferred speed. CONCLUSION Our results suggest that testing an athlete for asymmetry in hopping might help to understand what happens in running. For this purpose, further research is needed, especially in an injured population, to better understand the association between biomechanical asymmetry in hopping and running.
Collapse
|
5
|
De la Fuente C, Henriquez H, Carmont MR, Huincahue J, Paredes T, Tapia M, Araya JP, Díaz N, Carpes FP. Do the heel-rise test and isometric strength improve after Achilles tendon repair using Dresden technique? Foot Ankle Surg 2022; 28:37-43. [PMID: 33509663 DOI: 10.1016/j.fas.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achilles' tendon ruptures result in impaired plantar flexion strength and endurance. It is interesting to know the plantar flexion strength, the number of heel-rise repetitions, and the maximal calf circumference following Achilles' tendon ruptures repair. METHODS Both the injured and non-injured legs of thirty male patients with Achilles' tendon ruptures treated with the percutaneous Dresden technique were compared with the ankle function of 30 healthy participants. Rehabilitation involved partial weight-bearing for three weeks and then increased to full weight-bearing and ankle exercises. RESULTS The injured legs had weaker plantar flexion strength (1.64 ± 0.17 Nm/kg) compared with the non-injured legs (1.91 ± 0.24 Nm/kg; p = 0.002) and the healthy participants' legs (1.93 ± 0.32 Nm/kg; p < 0.001). The non-injured leg had greater ability in doing heel-rise repetitions (39.4 ± 6.1 rep.) compared with the injured legs (37.2 ± 5.7 rep.; p < 0.023) and the healthy participants' legs (31.0 ± 13.0 rep.; p < 0.001). CONCLUSIONS The injured leg had not recovered full isometric strength but had improved heel-rise repetition.
Collapse
Affiliation(s)
- Carlos De la Fuente
- Laboratory of Neuromechanics, Universidade Federal do Pampa #97500-970, Campus Uruguaiana, Uruguaiana, Brazil; Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile; Clinica MEDS, Santiago #7691236, Santiago, Chile; Centro de Salud Deportiva, Clinica Santa Maria, Santiago #7520380, Santiago, Chile
| | - Hugo Henriquez
- Centro de Salud Deportiva, Clinica Santa Maria, Santiago #7520380, Santiago, Chile; Traumatologia, Facultad de Medicina, Instituto Traumatológico-Universidad de Chile, Universidad de Chile, Santiago #8340220, Chile
| | - Michael R Carmont
- Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust #TF16TF, Shropshire, UK
| | - Javiera Huincahue
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Tamara Paredes
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - María Tapia
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Juan Pablo Araya
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Nicolás Díaz
- Interno de Medicina, Facultad de Medicina #8340220, Universidad de Chile, Santiago, Chile
| | - Felipe P Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa #97500-970, Campus Uruguaiana, Uruguaiana, Brazil.
| |
Collapse
|
6
|
Hoffman LR, Koppenhaver SL, MacDonald CW, Herrera JM, Streuli J, Visco ZL, Wildermuth N, Albin SR. Normative Parameters of Gastrocnemius Muscle Stiffness and Associations with Patient Characteristics and Function. Int J Sports Phys Ther 2021; 16:41-48. [PMID: 33604133 PMCID: PMC7872441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2023] Open
Abstract
BACKGROUND Quantifying muscle stiffness may aid in the diagnosis and management of individuals with muscle pathology. Therefore, the primary purpose of this study was to establish normative parameters and variance estimates of muscle stiffness in the gastrocnemius muscle in a resting and contracted state. A secondary aim was to identify demographic, anthropometric, medical history factors, and biomechanical factors related to muscle stiffness. METHODS Stiffness of the gastrocnemius muscle was measured in both a resting and contracted state in 102 asymptomatic individuals in this cross-sectional study. Differences based on muscle state (resting vs contracted) and sex (female vs male) were assessed using a 2 X 2 analysis of variance (ANOVA). Associations between muscle stiffness and sex, age, BMI, race, exercise frequency, exercise duration, force production, and step length were assessed using correlation analysis. RESULTS Gastrocnemius muscle stiffness significantly increased from a resting to a contracted state [mean difference: 217.5 (95% CI: 191.3, 243.8), p < 0.001]. In addition, muscles stiffness was 35% greater for males than females in a resting state and 76% greater in a contracted state. Greater muscle stiffness in a relaxed and contracted state was associated with larger plantarflexion force production (r = .26, p < 0.01 and r = .23, p < 0.01 respectively). CONCLUSION Identifying normative parameters and variance estimates of muscle stiffness in asymptomatic individuals may help guide diagnosing and managing individuals with aberrant muscle function. LEVEL OF EVIDENCE 2b Individual Cohort Study. CLINICAL RELEVANCE What is known about the subject: Muscle stiffness has been shown to be related to individuals with pathology such as Achilles tendinopathy; however, research is sparse regarding normative values of muscle stiffness. Measuring muscle stiffness may also be a way to potentially predict individuals prone to injury or to monitor the effectiveness of management strategies.What this study adds to existing knowledge: This study establishes defined estimates of muscle stiffness of the gastrocnemius in both a relaxed and contracted state in healthy individuals. Myotonometry measures of muscle stiffness demonstrated an increase in stiffness during contraction that varies by sex. Greater gastrocnemius muscle stiffness was associated with increased plantarflexion force production.
Collapse
|
7
|
Li YP, Feng YN, Liu CL, Zhang ZJ. Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e19519. [PMID: 32195954 PMCID: PMC7220386 DOI: 10.1097/md.0000000000019519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purposes of this study were to examine the feasibility of using the MyotonPRO digital palpation device in measuring the passive stiffness of gastrocnemius muscle belly and Achilles tendon; to determine between-days test-retest reliability of MyotonPRO; and to evaluate the acute effect of paraffin therapy on stiffness measurements in healthy participants. METHODS It is a randomized controlled trial. Twenty healthy participants (male, n = 10; female, n = 10; total, n = 20) were recruited to evaluate the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Dominant and nondominant legs were randomly divided into an experimental side (20 cases) and a control side (20 cases). The experimental side received 20 minutes of paraffin therapy. RESULTS The stiffness of muscle and tendon in the experimental side decreased significantly after paraffin therapy (P < .01), whereas no significant differences in stiffness measurements were found in the control side (P > .05). The passive stiffness of muscle and tendon was positively correlated with the ankle from 30° plantar flexion to10° dorsiflexion for dominant legs. Between-days test-retest reliability in stiffness measurements was high or very high (ICCs were above 0.737). CONCLUSION Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Furthermore, the MyotonPRO can reliably determine stiffness measurements.
Collapse
Affiliation(s)
- Ya Peng Li
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang
| | - Ya Nan Feng
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang
| | - Chun Long Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Luoyang
| |
Collapse
|
8
|
Walker J, Nicholson G, Jongerius N, Parelkar P, Harris N, Bissas A. Commonly reported isokinetic parameters do not reveal long-term strength deficits of the Triceps surae complex following operative treatment of Achilles tendon rupture. J Biomech 2020; 101:109630. [DOI: 10.1016/j.jbiomech.2020.109630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/04/2020] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
|
9
|
The acute and prolonged effects of 20-s static stretching on muscle strength and shear elastic modulus. PLoS One 2020; 15:e0228583. [PMID: 32027694 PMCID: PMC7004320 DOI: 10.1371/journal.pone.0228583] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/18/2020] [Indexed: 02/02/2023] Open
Abstract
Introduction Static stretching (SS) is commonly performed as part of warm-up routine. However, only few previous studies have reported on the effects of short-duration SS, which is often used in the sports field. The purpose of this study was to investigate the acute and prolonged effects of 20-s SS on isokinetic contraction muscle strength, range of motion (ROM), and the shear elastic modulus. Method Twenty male volunteers participated in this study. The ROM and both concentric and eccentric contraction muscle strengths were measured using a dynamometer. In addition, the shear elastic modulus of medial gastrocnemius muscle in dominant leg was measured by ultrasonic shear wave elastography. The participants visited the laboratory on four occasions each separated by >3 days. The first visit was a familiarization trial, and the subsequent three visits included the following experimental conditions in a random order. All measurements were performed prior to and immediately after SS or 5 min and 10 min after 20-s SS. Results The results of this study showed that the ROM was significantly increased SS intervention in all conditions compared with prior to SS intervention. In addition, ROM was significantly higher post SS and 5 min after SS than 10 min after SS. However, there were no significant interaction effects for isokinetic contraction muscle strength and the shear elastic modulus Conclusion In the sports field, from the point of performance, a 20-s SS intervention could be a useful technique before exercise because it increases ROM and does not decrease maximum torque.
Collapse
|
10
|
Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci Rep 2018; 8:17064. [PMID: 30459432 PMCID: PMC6244233 DOI: 10.1038/s41598-018-34719-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022] Open
Abstract
The purposes of this study were to compare Young’s modulus values determined by shear wave ultrasound elastography (SWUE) with stiffness index obtained using a hand-held MyotonPRO device on the resting stiffness of gastrocnemius muscle belly and Achilles tendon; and to examine the test-retest reliability of those stiffness measurement using hand-held MyotonPRO. Twenty healthy volunteers participated in the study. The measurement values of muscle and tendon was determined in dominant legs. Each marker point was assessed using MyotonPRO and SWUE, respectively. Intra-operator reliability of MyotonPRO was established in 10 of the subjects. The correlation coefficients between the values of muscle and tendon stiffness indices determined by MyotonPRO and SWUE were calculated. Significant correlations were found for muscle and tendon stiffness and Young’s modulus ranged from 0.463 to 0.544 (all P < 0.05). The intra-operator reliability ranged from good to excellent (ICC(3,1) = 0.787~0.928). These results suggest that the resting stiffness of gastrocnemius muscle belly and Achilles tendon measured by MyotonPRO is related to the Young’s modulus of those quantified by SWUE. The MyotonPRO shows good intra-operator repeatability. Therefore, the present study shows that MyotonPRO can be used to assess mechanical properties of gastrocnemius muscle belly and Achilles tendon with a resting condition.
Collapse
|
11
|
Orishimo KF, Schwartz-Balle S, Tyler TF, McHugh MP, Bedford BB, Lee SJ, Nicholas SJ. Can Weakness in End-Range Plantar Flexion After Achilles Tendon Repair Be Prevented? Orthop J Sports Med 2018; 6:2325967118774031. [PMID: 29845085 PMCID: PMC5967157 DOI: 10.1177/2325967118774031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair are thought to reflect increased tendon compliance or tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion for the first 12 weeks after surgery. Hypothesis Using stronger repairs and avoiding stretching into dorsiflexion would eliminate end-range plantar flexion weakness and normalize passive stiffness. Study Design Case series; Level of evidence, 4. Methods Achilles repairs with epitendinous augmentation were performed on 18 patients. Plantar flexion torque, dorsiflexion range of motion (ROM), passive joint stiffness, and standing single-legged heel rise on a decline were assessed at 43 ± 24 months after surgery (range, 9 months to 8 years). Maximum isometric plantar flexion torque was measured at 20° and 10° of dorsiflexion, neutral position, and 10° and 20° of plantar flexion. Passive dorsiflexion ROM was measured with a goniometer. Passive joint stiffness was computed from the increase in passive torque from 10° to 20° of dorsiflexion. Tendon thickness was measured by use of digital calipers. Plantar flexion electromyographic (EMG) data were recorded during strength and functional tests. Analysis of variance and chi-square tests were used to assess weakness and function. Results Marked weakness was evident on the involved side at 20° of plantar flexion (deficit, 26% ± 18%; P < .001), with no weakness at 20° of dorsiflexion (deficit, 6% ± 17%; P = .390). Dorsiflexion ROM was decreased 5.5° ± 8° (P = .015), and tendon width was 8 ± 3 mm greater on the involved side (P < .001). Passive joint stiffness was similar between the involved and noninvolved sides. Only 2 of 18 patients could perform a decline heel rise on the involved side compared with 18 of 18 on the noninvolved side (P = .01). No difference in EMG amplitude was found between the involved and noninvolved sides during the strength or heel rise tests. Conclusion The use of stronger repair techniques and attempts to limit tendon elongation by avoiding dorsiflexion stretching did not eliminate weakness in end-range plantar flexion. EMG data confirmed that end-range weakness was not due to neural inhibition. Physiological changes that alter the force transmission capability of the healing tendon may be responsible for this continued impairment. This weakness has implications for high-demand jumping and sprinting after Achilles tendon repair.
Collapse
Affiliation(s)
- Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Sidse Schwartz-Balle
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Timothy F Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Benjamin B Bedford
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Steven J Lee
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| |
Collapse
|