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Saab M, Derousseaux R, Beldame J, Chantelot C, Laboute E, Maynou C. Portable device for measuring isometric plantar-flexion force after open Achilles repair: Retrospective cohort of 30 recreational athletes with one-year minimum follow-up. Orthop Traumatol Surg Res 2023:103791. [PMID: 38072309 DOI: 10.1016/j.otsr.2023.103791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 02/25/2023] [Accepted: 08/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Plantar flexion force in recreational athletes after repair of Achilles tendon tears has rarely been reported, due to the lack of a widely available and fast measurement method. Knowledge of this parameter would allow optimisation of muscular and sports recovery. The main objective of this study was to measure the isometric force of the triceps surae at least 1 year after unilateral Achilles-tendon repair, comparatively to the unaffected side, using a portable device. The secondary objectives were to compare Achilles tendon and calf-muscle trophicity, dorsiflexion, and the single-leg heel-rise test versus the normal side and to assess functional scores at last follow-up. HYPOTHESES (i) Plantar flexion force does not differ significantly between the operated and contralateral sides. (ii) Calf-muscle trophicity, dorsiflexion, and the single-leg heel-rise test do not differ significantly between the operated and contralateral sides. PATIENTS AND METHODS This single-centre retrospective study included patients aged 18 to 65 years with a history of open repair of an acute unilateral Achilles tear at least 1 year earlier. Plantar flexion force, calf-muscle trophicity, dorsiflexion, and the heel-to-floor distance were measured on both sides and compared. The ATRS, VISA-A score, and EFAS score were determined. All complications were recorded. RESULTS The study included 30 patients with a mean follow-up of 20.3 months (range, 12-28 months). The operated side had significantly lower values for isometric triceps surae force, calf circumference, and heel-to-floor distance compared to the contralateral side (p<0.0001). Tendon width was significantly greater on the operated side (p<0.0001). Dorsiflexion did not differ significantly between sides (p=0.106). Mean functional score values were 91.5±6 for the ATRS (maximum, 100), 85±12 for the VISA-A score (maximum, 100), and 19.5±4 for the EFAS score (maximum, 24). DISCUSSION Isometric triceps-surae force measured using a portable device at least 1 year after open surgical Achilles-tendon repair was significantly decreased compared to the contralateral side. Calf circumference and heel-to-floor distance were also significantly lower. These data indicate a need for improved monitoring of triceps surae recovery to optimise rehabilitation and sports resumption. LEVEL OF EVIDENCE IV, retrospective comparative cohort study.
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Affiliation(s)
- Marc Saab
- Service d'Orthopédie -Traumatologie, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France.
| | - Romain Derousseaux
- Service d'Orthopédie -Traumatologie, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France
| | - Julien Beldame
- Institut de la Cheville et du Pied de Paris, 136, bis rue Blomet, 75015 Paris, France
| | - Christophe Chantelot
- Service d'Orthopédie -Traumatologie, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France
| | - Eric Laboute
- C.E.R.S. Groupe Ramsay Santé, 83, avenue Maréchal de Lattre de Tassigny, 40130 Capbreton, France
| | - Carlos Maynou
- Service d'Orthopédie -Traumatologie, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France
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Chuckpaiwong B, Glisson RR, Usuelli FG, Madi NS, Easley ME. Biomechanical Comparison of Nonlocked Minimally Invasive and Locked Open Achilles Tendon Simulated Rupture Repairs. Foot Ankle Int 2023; 44:913-921. [PMID: 37329183 DOI: 10.1177/10711007231178819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Open repair of Achilles tendon ruptures is associated with a risk of infection and other wound complications. Although percutaneous repairs reduce these complications, they may increase the risk of nerve injury. This study was designed to determine whether a percutaneous nonlocking repair can approach the gapping resistance offered by a standard open repair under conditions approximating typical postoperative physiotherapy. METHODS Ten pairs of cadavers Achilles tendons were transected in situ 5 cm above the insertion. One tendon from each pair was repaired using an open 4-strand Krackow locking loop, and the contralateral tendon was repaired with the Achillon system using the same suture material. Displacement transducers were attached to the medial, lateral, anterior, and posterior aspects of the tendon, spanning the repair. Each tendon underwent 1000 tensile loading cycles to 86.5 N, simulating passive ankle range-of-motion physiotherapy. Gapping was documented on the 1st, 50th, 100th, 500th, and 1000th cycles. The ultimate tensile strength of each repaired tendon was then measured by distracting until gross failure occurred. RESULTS Gapping of the percutaneous repairs exceeded that of conventional open repairs on the first, 500th, and 1000th load cycles. All 10 conventionally repaired tendons withstood 1000 load cycles without gross failure, but 4 of 10 percutaneous minimally invasive repairs failed, one on the 9th load cycle and the others between the 100th and 500th cycles. On average, tendons repaired with the open technique withstood 66% greater tensile load in failure testing than those repaired with the percutaneous technique. CONCLUSION Open Krackow Achilles tendon repairs may better withstand more aggressive postoperative physiotherapy than nonlocked percutaneous repairs. CLINICAL RELEVANCE The study suggests that surgeons should consider locking suture approaches to avoid loss of repair integrity with early motion.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Naji S Madi
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Altered Ankle Muscle Activation at 2-Year Post Achilles Tendon Repair: An Age, Gender, and Activity Level-Matched Comparison With Healthy Subjects. J Sport Rehabil 2023; 32:305-314. [PMID: 36623511 DOI: 10.1123/jsr.2022-0064] [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: 02/12/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 01/11/2023]
Abstract
CONTEXT The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. DESIGN Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. METHODS Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. RESULTS Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. CONCLUSIONS Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. LEVEL OF EVIDENCE Level III.
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Synthetic Graft Augmentation Is Safe and Effective for the Repair of Acute Achilles Tendon Rupture in Patients With Preexisting Tendinopathy. Arthrosc Sports Med Rehabil 2022; 4:e2079-e2087. [PMID: 36579039 PMCID: PMC9791818 DOI: 10.1016/j.asmr.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To assess the safety and report the clinical outcomes of synthetic graft augmentation using polypropylene (PP) mesh in the repair of acute Achilles tendon (AT) rupture in patients with preexisting tendinopathy. Methods: Patients who underwent open repair for acute AT rupture at our institution between April 2017 and March 2019 were retrospectively identified. The inclusion criteria were acute AT rupture in patients with preexisting tendinopathy. All patients included in the study underwent acute repair augmented by an inlay PP mesh and had 30 months' follow-up. Patient characteristics, operative details, and outcomes were analyzed. Continuous data were described by mean, standard deviation, median, and range. The Wilcoxon signed rank test was used to analyze the change in patient-reported outcome measures. The significance level was set at a P-value of .05. Results Thirteen patients were included. There were 5 female and 8 male patients, withan average age of 52 years (range 49-56 years). No cases of rerupture or graft-related complications requiring additional treatment occurred during mean follow -up of 38 months. All patients reported good functional outcome, as shown from nonsignificant difference between the preinjury and 38-month postoperative Achilles Tendon Rupture Score (88.5 ± 2.2 vs 89.2 ± 2.2, P = .107) and the excellent postoperative American Orthopedic Foot and Ankle Society Ankle/Hindfoot Scale score (92.22 ± 2.2) at last follow-up. At the end of follow-up, all patients were able to perform single-legged heel rise as the noninvolved side. By average of 16 weeks, all patients returned to their preinjury activity level. Conclusions The use of inlay PP mesh to augment the repair of acute AT rupture in patients with preexisting tendinopathy appears to be safe and effective, allowing early return to preinjury activity level with favorable clinical outcomes. Level of Evidence Level IV, therapeutic case series.
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Wenning M, Mauch M, Heitner A, Streicher P, Ritzmann R, Paul J. Midterm functional performance following open surgical repair of acute Achilles tendon rupture. Arch Orthop Trauma Surg 2022; 142:1337-1349. [PMID: 33484315 PMCID: PMC9217896 DOI: 10.1007/s00402-020-03746-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/19/2020] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair. MATERIALS AND METHODS This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. RESULTS At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p < 0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing. CONCLUSION In summary, there are persisting functional deficits at > 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Marlene Mauch
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
| | - Albrecht Heitner
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
| | - Paul Streicher
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Ritzmann
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
| | - Jochen Paul
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland.
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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]
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McHugh MP, Orishimo KF, Kremenic IJ, Adelman J, Nicholas SJ. Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair. Orthop J Sports Med 2019; 7:2325967119883357. [PMID: 31763342 PMCID: PMC6854752 DOI: 10.1177/2325967119883357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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 Weakness in end-range plantarflexion has been demonstrated after Achilles tendon repair and may be because of excessive tendon elongation. The mean frequency (MNF) of surface electromyogram (EMG) data during isometric maximum voluntary contraction (MVC) increases with muscle fiber shortening. Hypothesis During isometric plantarflexion, MNF during MVCs will be higher on the involved side compared with the uninvolved side after Achilles tendon repair because of excessive tendon elongation and greater muscle fiber shortening. Study Design Case series; Level of evidence, 4. Methods Isometric plantarflexion MVC torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantarflexion in 17 patients (15 men, 2 women; mean age, 39 ± 9 years) at a mean 43 ± 26 months after surgery. Surface EMG signals were recorded during strength tests. MNF was calculated from fast Fourier transforms of medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) EMG signals. Results Patients had marked weakness on the involved side versus the uninvolved side in 20° plantarflexion (deficit, 28% ± 18%; P < .001) but no significant weakness in 20° dorsiflexion (deficit, 8% ± 15%; P = .195). MNF increased when moving from dorsiflexion to plantarflexion (P < .001), but overall, it was not different between the involved and uninvolved sides (P = .195). However, differences in MNF between the involved and uninvolved sides were apparent in patients with marked weakness. At 10° plantarflexion, 8 of 17 patients had marked weakness (>20% deficit). MNF at 10° plantarflexion was significantly higher on the involved side versus the uninvolved side in patients with weakness, but this was not apparent in patients with no weakness (side by group, P = .012). Mean MNF at 10° plantarflexion across the 3 muscles was 13% higher on the involved side versus the uninvolved side in patients with weakness (P = .012) versus 3% lower in patients with no weakness (P = .522). Conclusion Higher MNF on the involved side versus the uninvolved side in patients with significant plantarflexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily because of excessive lengthening of the repaired Achilles tendon. If weakness was simply because of atrophy, a lower MNF would have been expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantarflexion after Achilles repair.
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Affiliation(s)
- Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Julia Adelman
- 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
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