| 1. |
- Ashnai, Farshad, et al.
(författare)
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The Calf Raise App shows good concurrent validity compared with a linear encoder in measuring total concentric work
- 2024
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Ingår i: KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. - 0942-2056 .- 1433-7347.
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe linear encoder and the Calf Raise App have been shown to be valid for measurements of plantar flexor muscular endurance in the heel raise test when compared with gold standard equipment. However, the validity of the Calf Raise App has not yet been compared with a linear encoder, an instrument commonly used in clinical and research settings. The purpose of this study was to determine the concurrent validity of the Calf Raise App compared with a linear encoder for the measurement of average heel raise height and total concentric work in the heel raise test.MethodsFifty TeamGym athletes (82% females) from an on-going prospective study were included (mean [SD] age: 20 [7] years; body mass index (BMI) = 21.3 [2.5]). Concurrent validity was analysed with single measures intraclass correlation coefficient (ICC) using a two-way mixed effects, consistency model.ResultsNinety-eight samples were included in the analysis. The mean (SD) average heel raise height and total concentric work measured by the linear encoder and Calf Raise App were 9.9 (1.4) and 7.5 (1.2) cm, and 1728 (584) and 1291 (450) J, respectively. The mean (SD) number of unilateral heel raises was 30 (7.5). The results showed poor to moderate concurrent validity for the measurement of average heel raise height (ICC: 0.62; 95% confidence interval [CI]: 0.48-0.73). Good to excellent concurrent validity was shown for the measurement of total concentric work (ICC: 0.89; 95% CI: 0.84-0.93).ConclusionThe Calf Raise App shows good concurrent validity in the heel raise test compared with a linear encoder in measuring total concentric work but not average height. While caution is recommended when comparing results from the different instruments, each instrument can be used separately to compare between-limb differences or changes over time in plantar flexor muscular endurance in clinical and research settings.Level of EvidenceLevel III. The concurrent validity of the Calf Raise App compared with a linear encoder was examined for measurements of average heel raise height and total concentric work in the heel raise test. Fifty participants were included. Good to excellent concurrent validity (intraclass correlation coefficient [ICC]: 0.89; 95% confidence interval [CI]: 0.84-0.93) was found for the measurement of total concentric work. image
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| 2. |
- Brorsson, Annelie, 1963, et al.
(författare)
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Injury Prevention in Basketball
- 2020
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Ingår i: Basketball Sports Medicine and Science. Laver L., Kocaoglu B., Cole B., Arundale A.J.H., Bytomski J., Amendola A. (eds). - Berlin, Tyskland : Springer-Verlag. - 9783662610695 ; , s. 657-663
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Brorsson, Annelie, 1963, et al.
(författare)
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The injured limb presents lower values in foot structure measurements 6 years after an achilles tendon rupture
- 2021
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Ingår i: Muscles, Ligaments and Tendons Journal. - : Edra SpA. - 2240-4554. ; 11:4, s. 694-703
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Tidskriftsartikel (refereegranskat)abstract
- Background. It is not known if foot structure may change after an Achilles tendon rupture and if a possible change may have an impact on lower limb function. The primary aim of the study was to explore the difference in foot structure between injured and healthy limb and between two treatment groups, at mean 6 years after an Achilles tendon rupture. A secondary aim was to explore if the differences in foot structure correlated with functional and clinical outcome. Methods. Ninety patients (15 women) with the mean (SD) age of 49 (9) years were evaluated. They had all been randomized to be treated with (n = 45) or without (n = 45) surgery. Foot structure was evaluated with Navicular Drop (Ndrop) and Drift (Ndrift), Longitudinal Arch Angle (LAA) and standing Dorsiflexion with knee straight and bent (DFstraight) and (DFbent). Calf muscle performance was evaluated with Single-leg standing heel-rise test and tendon length with ultrasound. For Patient-reported outcome measurements, Achilles tendon Total Rupture Score (ATRS) and Physical Activity Scale (PAS) were used. Both limbs were evaluated and the limb symmetry index (LSI (%) = injured/healthy × 100) was calculated. Results. In all patients, the injured limb demonstrated lower values (injured/healthy) in Ndrift (6.0/6.7 mm, p = 0.034), Ndrop (6.6/7.4 mm, p = 0.32) and DFbent (44/46°, p < 0.001). In the group treated with surgery, there was significant difference between limbs in DFbent (44/46°, p = 0.002). In the non-surgically treated group, the injured limb demonstrated significantly lower values in Ndrift (6.0/7.4 mm, p = 0.005), Ndrop (6.9/8.2 mm, p = 0.005) and DFbent (44/46°, p = 0.008). There was no difference between treatment groups in LSI-values. Conclusions. An Achilles tendon rupture seems to have an impact on foot structure long time after the injury. There is a need to clarify if the injury influences both feet and if there is a difference between treatment groups.
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| 4. |
- Carmont, Michael R, 1972, et al.
(författare)
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Achilles Tendon Ruptures in Basketball
- 2020
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Ingår i: Basketball Sports Medicine and Science. Laver L., Kocaoglu B., Cole B., Arundale A.J.H., Bytomski J., Amendola A. (eds). - Berlin, Heidelberg : Springer. - 9783662610701 ; , s. 481-489
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Basketball is a springing, jumping, and sprinting sport with players repetitively jumping to play shots and to make and receive passes or work sudden sprints together with the start–stop nature of the game. In the United States, sporting activity was responsible for 68% tendon ruptures, of which basketball was the most commonly involved sport, accounting for 48% of sports-related ruptures. There has been considerable debate as to whether operative or nonoperative treatment leads to the best outcome. Operative treatment may reduce the resultant calf muscle weakness, tendon elongation, predictability of outcome, and re-rupture rate compared with nonoperative treatment. Patients undergoing minimally invasive surgery are significantly more likely to report a satisfactory subjective outcome compared with open surgery. The overall rate of return to play (RTP) in all sports following Achilles tendon rupture has been estimated to 80%. However, for players in the National Basketball Association (NBA) who sustained an Achilles tendon rupture, more than a third (36.8%) either did not return to play or started in fewer than 10 games for the remainder of their career. Twenty-one percent of ruptures led to retirement. The mean time to return to play was 10.5 months, and the rate of return to play was lower in the NBA, 61–71%, compared with that of the National Football League players, 64–71%. Achilles tendon rupture in elite basketball players continues to be a serious, potentially career ending, injury.
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| 5. |
- Carmont, Michael R, 1972, et al.
(författare)
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Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture.
- 2020
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Ingår i: Orthopaedic journal of sports medicine. - : SAGE Publications. - 2325-9671. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management.To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair.Cohort study; Level of evidence, 3.From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI.A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m2). The elapsed time to surgery was 6.5 ± 4.0 days. At 12-month follow-up, patients had an HRHI of 82% ± 16% and performed 82% ± 17% of repetitions compared with the noninjured side. Participants had a mean ATRS of 87 ± 15 and a median Tegner score of 5 (range, 1-9), with a reduction in Tegner score of 2 from preinjury levels. The relative ATRA at 12 months was -4.8° ± 3.9°. Multiple regression identified younger age (B = ±0.006; P < .001) and greater intraoperative ATRA (B = 0.005; P = .053) as predictors of more symmetrical 12-month HRHI (R2 = 0.19; P < .001; n = 120).Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation.
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| 6. |
- Carmont, Michael R, 1972, et al.
(författare)
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Musculotendinous ruptures of the achilles tendon had greater heel-rise height index compared with mid-substance rupture with non-operative management: A retrospective cohort study
- 2024
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Ingår i: Journal of ISAKOS. - 2059-7754 .- 2059-7762.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Achilles tendon ruptures (ATRs) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR. Methods: The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace. Results: From February 2009 to August 2023, 556 patients presented with an ATR. Of these, 37 (6.7 %) patients were diagnosed with a MT tear. At final follow-up, at 12 months following injury, the MT group reported an Achilles tendon total rupture score (ATRS) of mean (standard deviation (SD)) of 83.6 (3.5) (95 % confidence interval (CI) 81.8, 85.4) and median (inter-quartile range (IQR)) ATRS of 86 points (78–95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59–95) (p = 0.673). Functional evaluation, however, revealed statistically significant differences in mean (SD) heel-rise height index MT group 79 % (25) (95%CI 65.9, 92.1) and MS group 59 % (13) (95%CI 51.9, 67.1) (p = 0.019). In the MT rupture group, there were considerably less complications than the MS rupture group. Conclusions: When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR. Level of evidence: IV.
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| 7. |
- Carmont, Michael R, 1972, et al.
(författare)
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No difference in achilles tendon resting angle, patient-reported outcome or heel-rise height index between non-and early-weightbearing the first year after an achilles tendon rupture
- 2020
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Ingår i: Muscles, Ligaments and Tendons Journal. - : Edra SpA. - 2240-4554. ; 10, s. 651-658
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Tidskriftsartikel (refereegranskat)abstract
- © 2020, CIC Edizioni Internazionali s.r.l.. All rights reserved. Background. Patient-reported outcome scores and comparable re-rupture rates in randomized controlled trials have not shown a definitive benefit for operative treatment after acute Achilles tendon rupture. This, together with the increasing rupture rates in the older age group has led to non-operative treatment being increasingly used. Objective. This study aimed to determine the variation in Achilles Tendon Resting Angle (ATRA) together with patient reported and functional outcome, with non-operative management of the ruptured Achilles tendon using two different regimes, which have been shown to offer low re-rupture rates. Methods. This is a non-randomised cohort comparison of Achilles tendon rupture patients managed with Non-Weight-Bearing (NWB) for 6 weeks vs. Early Weight-Bearing (EWB). The NWB-group received a cast in plantar flexion for 2 weeks followed by 6 weeks in a controlled ankle motion boot with incremental diminishing plantar flexion. The EWB-group received an initial anterior protective plaster slab in plantar flexion followed by 6 weeks of weight-bearing on the meta-tarsal heads, with an anterior shell restricting dorsiflexion. Results. At 12 months after the injury there were no differences in any of the variables between the two treatment groups. The NWB-group compared to the EWB-group reported at mean (SD) for ATRA-9.8˚ (4.6˚) versus-11.4˚ (5˚), p=0.32, for Achilles tendon Total Rupture Score (ATRS) 87 (10) versus 79 (19), p=0.43 and for Heel-Rise Height Index (HRHI) 71% (19%) versus 59% (13%), p=0.13. Conclusions. The two methods of non-operative treatment studied lead to increased relative ATRA following injury, however, patients report only minor limitation in terms of outcome. Patients had almost a third less heel-rise height compared with the non-injured ankle.
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| 8. |
- Carmont, Michael R, 1972, et al.
(författare)
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No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture.
- 2020
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 28, s. 1587-1594
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Tidskriftsartikel (refereegranskat)abstract
- This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients.Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation.Nine patients presented 21.8 (14.9)days (range 14-42days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5)days. There were no significant differences between groups: ATRA [mean (SD) delayed: -6.9° (5.5), acute: -6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury.Patients presenting more than 2weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair.III.
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| 9. |
- Carmont, Michael R, 1972, et al.
(författare)
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The influence of the COVID pandemic on the epidemiology of Achilles tendon ruptures in east Shropshire, United Kingdom
- 2023
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Ingår i: Journal of Isakos Joint Disorders & Orthopaedic Sports Medicine. - : Elsevier BV. - 2059-7754. ; 8:2, s. 94-100
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Management strategies of the COVID pandemic included isolation to prevent transmission. This study aimed to determine if the pandemic of 2020 influenced the epidemiology of Achilles tendon rupture (ATR).Methods: The demographics of presentations from the local population to Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust hospital, Shropshire, United Kingdom, with an ATR were analysed and compared together with the season, month, and year of the injury.Results: From 2009 to 2019, there was no significant change in the incidence of ATR over time with a mean (SD) incidence of 13.3 per 100,000. In 2020, there was a decrease in injuries with an incidence of 8.4 per 100,000, with an increase in 2021 to 22.4 per 100,000. In 2021, there was an increase in injuries from March with numbers maintained until October. The most common activity of ATR was team sport (36.2%), followed by the activities of daily living (28.9%), other physical activities (21.0%), and racket sports (13.9%). In 2020, there was the lowest number of injuries sustained in team and racket sports; however, in 2021, they accounted for over half of injuries.Conclusions: There were significantly more patients sustaining ATR in 2021, the year after the COVID pandemic and mandatory isolation. This was considered to be related to altered activity and team and racket sports during 2020.Levels of evidence: IV case series.
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| 10. |
- Carmont, Michael R, 1972, et al.
(författare)
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The release of adhesions improves outcome following minimally invasive repair of Achilles tendon rupture
- 2022
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 30, s. 1109-1117
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Operative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions. Methods From February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have been prospectively evaluated using the Achilles tendon Total Rupture Score (ATRS) and Heel-Rise Height Index (HRHI), following acute Achilles tendon rupture. Results Fourteen (5.6%) patients were identified as having adhesions. Four patients reported superficial adhesions and ten patients reported a deeper tightness of the tendon. At a mean (SD) of 10.5 (2.3) months following repair, the overall ATRS was at a median (IQR) 65 (44.5-78) points and (HRHI) was mean (SD) 81.5 (13.5)%. Of those deemed to have deep adhesions the antero-posterior diameter of the tendon was at mean (SD) 15.6 (4.6) mm. Open release of superficial adhesions resulted in improved ATRS in all patients. Endoscopic debridement anterior to the Achilles tendon led to alleviation of symptoms of tightness and discomfort from deep adhesions and improved outcome in terms of the ATRS score. At a mean (SD) of 15.9 (3.3)-month follow-up from initial rupture and repair, the patients reported at median (IQR) ATRS scores of 85 (64.8-92.8) points, Tegner level 5 (3-9) and mean (SD) HRHI 86.2 (9.5)%. Patients significantly improved both ATRS and HRHI following release at median (IQR) of 16.5 (- 1.8-29.3) points (p = 0.041) and mean (SD) 5.6 (8.3)% (p = 0.043). Conclusions The incidence of patient-reported adhesions following minimally invasive repair of Achilles tendon rupture was estimated to be 5.6%. The occurrence of superficial adhesions was associated with a lower outcome scores as well as symptoms of anterior tendon tightness and stiffness were associated with a lower score in most patients. Surgical release of adhesions led to a significant improvement in outcome.
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| 11. |
- Carmont, Michael R, 1972, et al.
(författare)
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The reliability, reproducibility and utilization of the radiographic Achilles Tendon Loading Angle in the management of Achilles Tendon rupture.
- 2021
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Ingår i: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. - : Elsevier BV. - 1460-9584. ; 27:7, s. 760-766
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Tidskriftsartikel (refereegranskat)abstract
- During 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.A 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.The 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).The 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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| 12. |
- Jonsdottir, Unnur Saedis, 1982, et al.
(författare)
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Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis
- 2023
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Achilles tendon rupture is common among physically active individuals, yet a high percentage fail to return to their former activity after the injury. Quantifiable factors such as type of treatment, hours of rehabilitation, and age have not been associated with return-to-play rates. A factor that influences recovery is the participant’s experience before and throughout the rehabilitation process, which can be explored using a qualitative content analysis. Purpose: To explore and describe what influences the participant to return to physical activity after an Achilles tendon rupture. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty participants (14 men; mean age, 46 years) were interviewed as part of this study. All participants had ruptured their Achilles tendon 4 to 6 years before the interviews. From the interviews, codes were extracted that evolved into 19 subcategories, 6 categories, and 1 theme. Results: The overarching theme that emerged was “Help me and then I can fix this.” The 6 categories were (1) one’s own drive to succeed, (2) having a supportive social network, (3) trusting the support from the health and social systems, (4) receiving and adapting information from others drives persistence in returning to activity, (5) impact of the injury on psychological factors; and (6) influence of physiological aspects. Conclusion: To be able to recover properly from an Achilles tendon rupture and return to activity, the study participants described the importance of obtaining the support needed to be able to gain optimal rehabilitation. In the participants’ opinion, for a greater chance of successful treatment and rehabilitation, it was vital to be provided with good support.
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| 13. |
- Jónsdóttir, Unnur Saedis, et al.
(författare)
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The effect of fear of reinjury on joint power distribution during a drop countermovement jump two years after an Achilles tendon rupture
- 2021
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Ingår i: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 4:5, s. 667-674
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of Achilles tendon rupture (ATR) is increasing and at least 20% do not return to preinjury activity. The aim of the study was to evaluate biomechanical differences between those assigned to a Fear group and No-Fear group based on fear of reinjury during activity after ATR, by evaluating a drop countermovement jump. Twenty-five participants were evaluated 23.5 months after ATR. Peak values for eccentric and concentric joint power were identified for ankles, knees, and hips. Participants were assigned to Fear group or No-Fear group depending on their answers to a question regarding fear of reinjury during activities. Interlimb peak power was compared between groups for landing and push-off with a mixed model ANOVA. Compared to the No-fear group, the Fear group presented significant decreased power in the ankle (P < .001) but increased power in the knee (P < .001) in involved limb during both phases. A 3-way interaction was found between group, side, and phase for frontal plane hip power (P < .001). Our findings indicate that those who are afraid of reinjury demonstrate higher interlimb differences compared to those who are not. They also compensate for ankle deficits with greater knee and hip power.
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| 14. |
- Larsson, Elin, et al.
(författare)
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ABC om Kronisk hälsenesmärta – diagnos och behandling
- 2021
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Ingår i: Läkartidningen. - 0023-7205. ; 119:11-12
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Achilles tendinopathy is a common overuse injury, especially among runners. It should be divided into midportion Achilles tendinopathy and insertional Achilles tendinopathy, as the treatments are different. Achilles tendinopathy is a clinical diagnosis, which includes a combination of pain, swelling and stiffness. If pain is located 2-6 cm above the insertion to the calcaneus, it is considered a midportion tendinopathy. Pain located more distally, close to the insertion, is defined as insertional tendinopathy. Both midportion and insertional Achilles tendinopathies are primarily treated with physiotherapy during three to six months. Exercise has the highest level of evidence and is more successful in midportion Achilles tendinopathy. Insertional tendinopathy more often requires surgical treatment, with removal of bony exostosis and chronically inflamed bursa.
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| 15. |
- Larsson, Elin, 1996, et al.
(författare)
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Achilles tendon resting angle is able to detect deficits after an Achilles tendon rupture, but it is not a surrogate for direct measurements of tendon elongation, function or symptoms
- 2022
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 30, s. 4250-4257
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to investigate how the Achilles tendon resting angle (ATRA), an indirect measurement of tendon elongation, correlates with ultrasonography (US) measurements of the Achilles tendon length 6 and 12months after an acute ATR and relates to other clinical outcome measurements such as heel-rise height, jumping ability and patient-reported outcome measurements (PROMs). Methods: Patients were included following acute Achilles tendon rupture (ATR). Achilles tendon length, ATRA, heel-rise height (HRH), drop countermovement jump (Drop CMJ) and PROMs (Achilles tendon total rupture score (ATRS) and physical activity scale (PAS)) were evaluated 6 and 12months after injury. Achilles tendon length was evaluated using US, while the ATRA was measured with a goniometer. Results: Sixty patients (13 women, 47 men), mean (SD) age 43 (9) years, with an acute ATR undergoing either surgical (35%) or non-surgical (65%) treatment were evaluated. A negative correlation (r = − 0.356, p = 0.010) between relative ATRA and tendon elongation was seen at 12months after ATR. There were also significant positive correlations at 6 and 12months between relative ATRA and HRH (r = 0.330, p = 0.011 and r = 0.379, p = 0.004). There were no correlations between ATRA and ATRS or ATRA and Drop CMJ, at either 6 or 12months after the injury. Conclusion: In combination with other clinical evaluations such as HRH and US, ATRA could be a clinical tool for indirect measurements of tendon elongation. However, ATRA cannot be recommended as a direct surrogate for US for determining Achilles tendon length. Level of evidence: III.
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| 16. |
- Larsson, Elin, 1996, et al.
(författare)
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Females present larger deficit in heel-rise height at 3 months following an Achilles tendon rupture compared with males
- 2024
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Ingår i: KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. - 0942-2056 .- 1433-7347.
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThere is a lack of knowledge concerning differences between females and males in the early stages after an acute Achilles tendon rupture. This article aims to explore the different factors affecting early function after an Achilles tendon rupture with a validated test battery that includes functional tests, clinical measurements and patient-reported outcome at a 3-month follow-up analysis of a larger prospective study.MethodsThis study was part of the DUSTAR-study (Diagnostic UltraSonography for the choice of Treatment of acute Achilles tendon Rupture) where the main aim was to evaluate if an acute ultrasonography could determine which patients, with an Achilles tendon rupture, should be treated surgically or nonsurgically. At the 3-month follow-up, the results between males and females were compared.ResultsOne hundred and twenty-seven patients were included at the 3-month follow-up; of these, 102 (80%) were males and 25 (20%) were females. Amongst the females, 11 (44%) were able to perform a single leg heel-rise compared to 48 (47%) of the males; however, the difference was not statistically significant. There was no difference between the sexes in the frequency of completing a single-leg heel-rise at 3 months after injury; however, there were statistically significant differences between the groups when comparing Limb Symmetry Index (LSI) of heel-rise height and heel-rise work. The females had a median heel-rise height LSI/median heel-rise work LSI of 45%/14% compared to males who reached a level of 57%/23% (p = 0.006/p = 0.010). At the 3-month follow-up, the median (range) Achilles tendon Total Rupture Score (ATRS) reported by females was 28.5 (8-51), which had a nonsignificant difference compared to males who reported a median (range) ATRS of 30 (1-86).ConclusionThe risk of reduced heel-rise height and worse heel-rise work 3 months after an acute Achilles tendon rupture increases by being a female. Through this knowledge, we highlighted the importance of an individualised treatment for acute Achilles tendon ruptures with better outcome for both males and females.Level of EvidenceLevel II.
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| 17. |
- Larsson, Elin, et al.
(författare)
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Sex differences in patients' recovery following an acute Achilles tendon rupture - a large cohort study
- 2022
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Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders. Aims The primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients. Methods Data were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Molndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men. Results A total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS. Conclusion To our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.
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| 18. |
- Nilsson, Niklas, 1995, et al.
(författare)
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Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures - a systematic review.
- 2023
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Ingår i: BMC musculoskeletal disorders. - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft.A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS).Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2-13) for all studies.Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult.Level IV.
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| 19. |
- Nilsson, Niklas, et al.
(författare)
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Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques.
- 2022
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 30:7, s. 2477-2484
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Tidskriftsartikel (refereegranskat)abstract
- Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re-ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps.Twenty-two patients (13 males and 9 females) with a median (range) age of 64 (34-73) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12months post-operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel-rise height and repetitions together with tendon length determined by ultrasonography, concentric heel-rise power and heel-rise work.The patients reported a median (range) ATRS of 76 (45-99) out of 100. The median (range) ATRA on the injured side was 60° (49°-75°) compared with 49.5° (40-61°), p<0.001, on the non-injured side. Eighteen out of 22 patients were able to perform a single-leg heel-rise on the non-injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel-rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non-injured side with a median (range) heel-rise repetitions of 11 (2-22) compared with 26 (2-27), (p<0.001), and a median (range) heel-rise height of 5.5cm (1.0-11.0cm) compared with 9.0cm (5.0-11.5cm), (p<0.001). The median calf circumference was 1.5cm smaller on the injured side, 37.5cm compared with 39cm, when medians were compared. The median (range) tendon length of the injured side was 24.8cm (20-28.2cm) compared with 22cm (18.4-24.2cm), (p<0.001), on the non-injured side.The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re-ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel-rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction.IV.
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| 20. |
- Nilsson, Niklas, 1995, et al.
(författare)
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Evaluation of the Achilles Tendon
- 2023
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Ingår i: The Art of the Musculoskeletal Physical Exam. - 9783031244049 ; , s. 539-546
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Bokkapitel (refereegranskat)abstract
- The Achilles tendon often withstands extensive power and is commonly subject to acute ruptures and chronic overuse pathologies. The incidence of Achilles tendon ruptures and Achilles tendinopathy is increasing, and a thorough clinical examination is essential in establishing the diagnosis. To fully recover from Achilles tendon rupture and Achilles tendinopathy, a well-planned rehabilitation programme is necessary. An early diagnosis can therefore help the patient to recover from injury more rapidly. Basic knowledge on the anatomy of the lower leg and a well-executed clinical examination are necessary to establish the diagnosis. The clinical examination of the Achilles tendon consists of inspection and palpation of the Achilles tendon and surrounding tissues. Another part of the examination is passive and active plantar flexion of the foot. For acute injuries and Achilles tendon ruptures, the calf squeeze test and Matles’ test are well acknowledged and useful. The corresponding tests that may be used for chronic overuse syndromes are the “painful arc sign” and the Royal London Hospital test. Even though the clinical examination is considered sufficient, plain radiographs, ultrasonography, and MRI can be of help to establish the diagnosis and deciding on further management of the Achilles tendon injury. There are several patient-reported outcome measurements (PROMs) used in Achilles tendon injury management and rehabilitation. The Achilles tendon total rupture score (ATRS) is commonly used for Achilles tendon ruptures and the Victorian Institute of Sports Assessment-Achilles (VISA-A) for Achilles tendinopathy.
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| 21. |
- Nilsson, Niklas, 1995, et al.
(författare)
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The Delayed Presentation of Achilles Tendon Ruptures Is Associated With Marked Alterations in the Gene Expression of COL1A1, MMPs, TIMPs, and IL-6
- 2024
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Ingår i: American Journal of Sports Medicine. - : SAGE PUBLICATIONS INC. - 0363-5465 .- 1552-3365. ; 52:1, s. 164-173
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Tidskriftsartikel (refereegranskat)abstract
- Background: Both acute and chronic Achilles tendon ruptures are affected by alterations in the extracellular matrix during the healing process of the tendon. Yet, these alterations in gene expression patterns are not well characterized. Purpose: To characterize temporal and spatial differences in gene expression patterns after an Achilles tendon rupture and to evaluate if cells from chronic Achilles tendon ruptures have the same ability to form new tendon tissue (tendon constructs) as healthy tendon cells. Study Design: Controlled laboratory study. Methods: A total of 35 patients with surgically treated Achilles tendon ruptures were included in the study and divided into 3 groups: acute (<4 weeks), short-term chronic (1-6 months), and long-term chronic (>6 months). Biopsy specimens were collected during surgical repair and were used to analyze the gene expression within the different groups and to compare mRNA levels in the proximal and distal tendon ends. A complementary in vitro experiment was performed to evaluate if cells from chronic Achilles tendon ruptures can form tendon constructs. Results: The mRNA levels for COL1A1 and COL3A1 were significantly higher in the short-term chronic group compared with the acute group (P <.05). Both MMP-1 and MMP-13 had the highest mRNA levels in the acute group (P <.01) compared with the long-term chronic group, while MMP-2 had the highest mRNA level in the short-term chronic group. Significant differences between the proximal and distal tendon ends were only detected for the monocyte and macrophage marker CD163 (P <.05), which was more expressed proximally. Cells extracted from chronic Achilles tendon ruptures displayed a similar ability and effectiveness to form tendon constructs as healthy tendon cells. Conclusion: A high collagenase gene activity after an Achilles tendon rupture indicated possible rapid matrix degradation in the acute phase. Chronic ruptures appeared to initiate the healing process even before treatment, indicated by the higher expression of collagen in the short-term chronic group. Cells from chronic Achilles tendon ruptures also displayed an ability to form new tendon tissue in vitro. Clinical Relevance: The study shows a rapid increase in collagenase gene expression, which could lead to matrix degradation that continues for months after an Achilles tendon rupture.
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| 22. |
- Zellers, Jennifer A, et al.
(författare)
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Impact of seated and standing positions on triceps surae muscle activation in unilateral Achilles tendon rupture
- 2020
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Ingår i: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 3:1, s. 3-8
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Tidskriftsartikel (refereegranskat)abstract
- Heel rises are commonly used in the rehabilitation of individuals following Achilles tendon rupture; however, the impact of tendon elongation on triceps surae activation in seated versus standing positions has not been investigated. The purpose of this study was to investigate changes in triceps surae activation during seated compared to standing heel rises in individuals with Achilles tendon rupture and its relationship to tendon elongation. Ten individuals with a history of Achilles tendon rupture were included in this study. Muscle activity using electromyography was examined during a heel rise task in seated (unilateral) and standing (bilateral) positions. Soleus activity was not significantly different between sitting and standing on both the ruptured and uninjured side. On the ruptured, side there were no differences in medial or lateral gastrocnemius activity between sitting and standing; however, on the uninjured side medial and lateral gastrocnemius activity was lower in sitting compared to standing. The results of this study suggest that neuromuscular changes in triceps surae activation occur following Achilles tendon rupture. The seated heel rise position can be used to strengthen all muscles of the triceps surae and is useful when the patient is unable to perform a standing heel rise.
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