TY - JOUR

T1 - 1.7 cm elongated Achilles tendon did not alter walking gait kinematics 4.5 years after non-surgical treatment

AU - Kastoft, Rasmus

AU - Barfod, Kristoffer

AU - Bencke, Jesper

AU - Speedtsberg, Merete B.

AU - Hansen, Sanja Bay

AU - Penny, Jeannette O.

PY - 2022

Y1 - 2022

N2 - Purpose The aim of the present study was to evaluate Achilles tendon length after non-surgical treatment of acute Achilles tendon rupture (aATR), and to evaluate indirect effects of possible persistent elongation on kinematics. Methods The study was performed as a cross-sectional study based on a population of patients from an RCT regarding non-operative treatment of aATR. Thirty-seven patients out of the 56 in the original RCT participated with at a follow up of 4-5 years after aATR. Primary outcome was Achilles tendon elongation. Additional outcomes were Achilles tendon resting angle (ATRA), calf circumference, passive ankle plantar and dorsiflexion and loading pattern. Foot pressure mapping was performed to measure plantar loading distribution pattern; medial and lateral forefoot peak pressure, heel peak pressure, medial versus lateral loading pattern and timing of heel lift during roll over process. The healthy leg was used as a control. Results The injured Achilles tendon was significantly elongated by 1.7 (SD 1.6) cm compared to the non-injured leg. A slight delay of 2.6% (SD 6.0) was measured in heel lift in the injured side compared to the non-injured leg. We found no significant difference in forefoot peak pressure, medial and lateral peak pressure as well as heel peak pressure, and no correlation was found between Achilles tendon length and pressure measurements. Finally, dorsiflexion was 1.9 degrees(SD1.28) larger, ATRA 8.1 degrees(SD6.7) larger, and calf circumference 1.6 cm (SD1.1) lower on the injured leg. Conclusion The Achilles tendon was 1.7 cm elongated 4.5 years after the initial injury and significant changes in ATRA, calf circumference and passive dorsiflexion was present. Except for a slight delay in heel lift-off, kinematics during walking was symmetrical between injured and healthy leg, even with an elongated tendon on the injured leg. The clinical relevance of the Achilles tendon elongation is uncertain. Clinical trials identifier NCT02760784.

AB - Purpose The aim of the present study was to evaluate Achilles tendon length after non-surgical treatment of acute Achilles tendon rupture (aATR), and to evaluate indirect effects of possible persistent elongation on kinematics. Methods The study was performed as a cross-sectional study based on a population of patients from an RCT regarding non-operative treatment of aATR. Thirty-seven patients out of the 56 in the original RCT participated with at a follow up of 4-5 years after aATR. Primary outcome was Achilles tendon elongation. Additional outcomes were Achilles tendon resting angle (ATRA), calf circumference, passive ankle plantar and dorsiflexion and loading pattern. Foot pressure mapping was performed to measure plantar loading distribution pattern; medial and lateral forefoot peak pressure, heel peak pressure, medial versus lateral loading pattern and timing of heel lift during roll over process. The healthy leg was used as a control. Results The injured Achilles tendon was significantly elongated by 1.7 (SD 1.6) cm compared to the non-injured leg. A slight delay of 2.6% (SD 6.0) was measured in heel lift in the injured side compared to the non-injured leg. We found no significant difference in forefoot peak pressure, medial and lateral peak pressure as well as heel peak pressure, and no correlation was found between Achilles tendon length and pressure measurements. Finally, dorsiflexion was 1.9 degrees(SD1.28) larger, ATRA 8.1 degrees(SD6.7) larger, and calf circumference 1.6 cm (SD1.1) lower on the injured leg. Conclusion The Achilles tendon was 1.7 cm elongated 4.5 years after the initial injury and significant changes in ATRA, calf circumference and passive dorsiflexion was present. Except for a slight delay in heel lift-off, kinematics during walking was symmetrical between injured and healthy leg, even with an elongated tendon on the injured leg. The clinical relevance of the Achilles tendon elongation is uncertain. Clinical trials identifier NCT02760784.

KW - Achilles tendon rupture

KW - Conservative

KW - Non-operative

KW - Early weight-bearing

KW - Achilles tendon length

KW - Foot pressure mapping

KW - Achilles tendon resting angle

KW - ATRA

KW - RESTING ANGLE

KW - DYNAMIC TREATMENT

KW - ACUTE RUPTURES

KW - LENGTH

KW - TRIAL

KW - WEIGHTBEARING

KW - OUTCOMES

KW - ATROPHY

KW - SURGERY

KW - HEIGHT

U2 - 10.1007/s00167-022-06874-y

DO - 10.1007/s00167-022-06874-y

M3 - Journal article

C2 - 35234975

VL - 30

SP - 3579

EP - 3587

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

ER -