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- Carmont, Michael R, 1972, et al.
(author)
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Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture.
- 2020
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In: Orthopaedic journal of sports medicine. - : SAGE Publications. - 2325-9671. ; 8:3
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Journal article (peer-reviewed)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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| 2. |
- Carmont, Michael R, 1972, et al.
(author)
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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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In: 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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Journal article (peer-reviewed)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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| 3. |
- Grävare Silbernagel, Karin, et al.
(author)
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ICON 2020 - International Scientific Tendinopathy Symposium Consensus : A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy
- 2022
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In: Sports Medicine. - : Springer Nature. - 0112-1642 .- 1179-2035. ; 52, s. 613-641
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Research review (peer-reviewed)abstract
- Background: Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated.Objective: To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains.Design: Systematic review.Data Sources: Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar.Eligibility Criteria for Selecting Studies: Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series.Results: 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain.Conclusion: 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures.Prospero Registration: CRD42020156763.
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| 4. |
- Heijne, Annette, et al.
(author)
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"I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either" : Patients' experiences of a second ACL injury-an interview study
- 2021
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347.
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this qualitative study was to describe women's experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury.METHODS: Eight women between 17 and 36 years (mean 26, SD 6.5) who had experienced ACLR, followed by another ACL rupture, participated in the study. Semi-structured interviews were conducted, and data were analyzed using qualitative content analysis.RESULTS: One overarching theme, "Rehabilitation after a second ACL injury-A lifelong adaptive coping process", emerged from analyses. Undergoing a second rehabilitation is described as a process of adaptation, beginning with the first injury and still ongoing, more than 5 years later. Participants applied different coping strategies to adapt to these life-altering injuries, but the common denominator was of major life adjustments with no return to previous activity levels. Initially, after the reinjury, it was about coping with the catastrophe of the dreaded second injury. Over time, they accepted their "new" life and reset their recovery/rehabilitation goal not just as "return to sport" but rather as a "personal life goal".CONCLUSION: Undergoing a second ACL injury is a long process that challenges the patient's coping skills. Given these results, rehabilitation programs need to be more person centred according to the patients-adjusted life goals.LEVEL OF EVIDENCE: 3.
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| 5. |
- Larsson, Elin, 1996, et al.
(author)
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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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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 30, s. 4250-4257
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Journal article (peer-reviewed)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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| 6. |
- Zellers, Jennifer A, et al.
(author)
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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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In: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 3:1, s. 3-8
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Journal article (peer-reviewed)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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