Gastrocnemius Muscle Structure Remodels Within the First Month Following Acute Achilles Tendon Rupture

Category: Sports, Trauma, Achilles Tendon Introduction/Purpose: Two out of three patients Achilles tendon ruptures have limited plantarflexor function 1-year following Achilles tendon rupture. While tendon elongation has been reported as a possible mechanism of functional deficits, the effects of rupture on plantarflexor muscle structure has not been as rigorously investigated. A recent study found that gastrocnemius fascicle length was decreased 6-months following Achilles tendon rupture compared to the uninjured limb. However, the changes in muscle structure following the first month of injury – when the healing tendon is most susceptible to elongation – has not yet been established. The purpose of this study was to quantify the structural changes to the medial gastrocnemius in patients who suffered acute Achilles tendon ruptures and were treated non-operatively. Methods: To test our hypothesis that plantarflexor structure would undergo rapid remodeling following Achilles tendon rupture, we quantified muscle structure in ten patients (9 male, Age: 44 ± 12; BMI: 28.6 ± 6.5) who provide informed written consent in this IRB approved study. We acquired B-mode ultrasound images of the medial gastrocnemius muscle at the initial presentation (week 0), two weeks, and four weeks following the injury. The same investigator acquired all the ultrasound images and measured fascicle length, pennation angle, muscle thickness, and echo intensity. These measurements had a coefficient of variation less than 10%. We compared these structural measurements of the injured muscle at each time point with the contralateral muscle scans at the initial presentation using paired t-tests. Results: Gastrocnemius muscle structure following an acute Achilles tendon rupture differed with the healthy-contralateral muscle throughout the first four weeks following injury (Figure). Fascicle length was 15% shorter (P < 0.001) and pennation angle was 21% greater (P < 0.001) at the presentation of injury (week 0). These differences in fascicle length (P < 0.001) and pennation angle persisted throughout the 4 weeks after the injury (P < 0.008). Muscle thickness changes were not detected at any of the post-injury visits. Muscle quality, measured as mean echo intensity, was 8% lower in the injured limb immediately (P= 0.008) and 11% lower 2 weeks following injury (P < 0.001). At week 4 muscle quality had returned to within 1% of the contralateral limb (P = 0.393). Conclusion: Our findings support our hypothesis that the gastrocnemius muscle fascicles of the affected side would demonstrate shorter length and greater pennation angle than the contralateral control muscle. These findings are a preliminary set of data from a larger clinical cohort of patients that were enrolled in an ongoing 1-year long prospective study. Achilles tendon ruptures elicit rapid changes in the configuration and quality of the medial gastrocnemius, which may explain long-term functional deficits.

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Gastrocnemius muscle remodeling explains functional deficits three months following Achilles tendon rupture

10.1101/585505 ◽

2019 ◽

Cited By ~ 1

Author(s):

Todd J. Hullfish ◽

Kathryn M. O’Connor ◽

Josh R. Baxter

Keyword(s):

Achilles Tendon ◽

Gastrocnemius Muscle ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Peak Torque ◽

Pennation Angle ◽

Medial Gastrocnemius ◽

Fascicle Length ◽

Functional Deficits ◽

Muscle Remodeling

ABSTRACTPlantarflexor functional deficits are associated with poor outcomes in patients following Achilles tendon rupture. In this longitudinal study, we analyzed the fascicle length and pennation angle of the medial gastrocnemius muscle and the length of the Achilles tendon using ultrasound imaging. To determine the relationship between muscle remodeling and functional deficits measured at 3 months after injury, we correlated the reduction in fascicle length and increase in pennation angle with peak torque measured during isometric plantarflexor contractions and peak power measured during isokinetic plantarflexor contractions. We found that the medial gastrocnemius underwent an immediate change in structure, characterized by decreased length and increased pennation of the muscle fascicles. This decrease in fascicle length was coupled with an increase in tendon length. These changes in muscle-tendon structure persisted throughout the first three months following rupture. Deficits in peak plantarflexor power were moderately correlated with decreased fascicle length at 120 degrees per second (R2= 0.424,P= 0.057) and strongly correlated with decreased fascicle length at 210 degrees per second (R2= 0.737,P= 0.003). However, increases in pennation angle did not explain functional deficits. These findings suggest that muscle-tendon structure is detrimentally affected following Achilles tendon rupture. Plantarflexor power deficits are positively correlated with the magnitude of reductions in fascicle length. Preserving muscle structure following Achilles tendon rupture should be a clinical priority to maintain patient function.

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Medial gastrocnemius muscle remodeling correlates with reduced plantarflexor kinetics 14 weeks following Achilles tendon rupture

Journal of Applied Physiology ◽

10.1152/japplphysiol.00255.2019 ◽

2019 ◽

Vol 127 (4) ◽

pp. 1005-1011 ◽

Cited By ~ 5

Author(s):

Todd J. Hullfish ◽

Kathryn M. O’Connor ◽

Josh R. Baxter

Keyword(s):

Achilles Tendon ◽

Gastrocnemius Muscle ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Peak Torque ◽

Pennation Angle ◽

Medial Gastrocnemius ◽

Fascicle Length ◽

Muscle Remodeling ◽

Medial Gastrocnemius Muscle

Deficits in plantarflexor kinetics are associated with poor outcomes in patients following Achilles tendon rupture. In this longitudinal study, we analyzed the fascicle length and pennation angle of the medial gastrocnemius muscle and the length of the Achilles tendon using ultrasound imaging. To determine the relationship between muscle remodeling and deficits in plantarflexor kinetics measured at 14 wk after injury, we correlated the reduction in fascicle length and increase in pennation angle with peak torque measured during isometric and isokinetic plantarflexor contractions. We found that the medial gastrocnemius underwent an immediate change in structure, characterized by decreased length and increased pennation of the muscle fascicles. This decrease in fascicle length was coupled with an increase in tendon length. These changes in muscle-tendon structure persisted throughout the first 14 wk following rupture. Deficits in peak plantarflexor torque were moderately correlated with decreased fascicle length at 120 degrees per second ( R2 = 0.424, P = 0.057) and strongly correlated with decreased fascicle length at 210 degrees per second ( R2 = 0.737, P = 0.003). However, increases in pennation angle did not explain functional deficits. These findings suggest that muscle-tendon structure is detrimentally affected following Achilles tendon rupture. Plantarflexor power deficits are positively correlated with the magnitude of reductions in fascicle length. Preserving muscle structure following Achilles tendon rupture should be a clinical priority to maintain plantarflexor kinetics. NEW & NOTEWORTHY In our study, we found that when the Achilles tendon ruptures due to excessive biomechanical loading, the neighboring skeletal muscle undergoes rapid changes in its configuration. The magnitude of this muscle remodeling explains the amount of ankle power loss demonstrated by these patients once their Achilles tendons are fully healed. These findings highlight the interconnected relationship between muscle and tendon. Isolated injuries to the tendon stimulate detrimental changes to the muscle, thereby limiting joint-level function.

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Functional Deficits are Explained by Plantarflexor Remodeling Following Achilles Tendon Rupture Repair: Preliminary Findings

10.1101/290833 ◽

2018 ◽

Cited By ~ 3

Author(s):

Josh R. Baxter ◽

Todd J. Hullfish ◽

Wen Chao

Keyword(s):

Skeletal Muscle ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Medial Gastrocnemius ◽

Fascicle Length ◽

Functional Deficits ◽

Limited Function ◽

Poor Outcomes ◽

Muscle Remodeling

AbstractAchilles tendon ruptures are painful injuries that often lead to long-term functional deficits. Despite the prevalence of these injuries, the mechanism responsible for limited function has not yet been established. Therefore, the purpose of this study was to present preliminary findings that support a hypothesis that skeletal muscle remodeling is the driving factor of poor outcomes in some patients. Biomechanical and ultrasonography assessments were performed on a patient that presented with poor functional outcomes 2.5 years after a surgically-repaired acute Achilles tendon rupture. Single-leg heel raise function was decreased by 70% in the affected limb while walking mechanics showed no deficits. Ultrasonography revealed that the affected limb had shorter, more pennated, and less thick medial gastrocnemius muscles compared to the unaffected limb. A simple computational model of a maximal-effort plantarflexion contraction was employed to test the implications of muscle remodeling on single-leg heel raise function. Subject-specific fascicle length and pennation measurements explained deficits in ankle work and power that strongly agreed with experimentally measured values using motion capture. These preliminary findings support the hypothesis that skeletal muscle goes extensively remodels in response to a ruptured tendon, which reduces the amount of work and power the joint can generate. This multidisciplinary framework of biomechanical, imaging, and computational modeling provides a unique platform for studying the complex interactions between structure and function in patients recovering from Achilles tendon injuries.

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Gastrocnemius fascicles are shorter and more pennate throughout the first month following acute Achilles tendon rupture

10.1101/445569 ◽

2018 ◽

Cited By ~ 1

Author(s):

Todd J. Hullfish ◽

Kathryn M O’Connor ◽

Josh R. Baxter

Keyword(s):

Achilles Tendon ◽

Muscle Thickness ◽

Pennation Angle ◽

Medial Gastrocnemius ◽

Ultrasound Images ◽

Echo Intensity ◽

Post Injury ◽

Fascicle Length ◽

Clinical Visit ◽

Tendon Ruptures

AbstractThe purpose of this study was to characterize the short-term effects of Achilles tendon ruptures on medial gastrocnemius. We hypothesized that the fascicles of the medial gastrocnemius muscle of the injured Achilles tendon would be shorter and more pennate immediately following the injury and would persist throughout 4 weeks post-injury. B-mode longitudinal ultrasound images of the medial gastrocnemius were acquired in 10 adults who suffered acute Achilles tendon ruptures and were treated non-operatively. Ultrasound images were acquired during the initial clinical visit following injury as well as two and four weeks following this initial clinical visit. Resting muscle structure was characterized by measuring fascicle length, pennation angle, muscle thickness, and muscle echo intensity in both the injured and contralateral (control) limbs. Fascicle length was 15% shorter (P < 0.001) and pennation angle was 21% greater (P < 0.001) in the injured muscle compared to the uninjured (control) muscle at the presentation of injury (week 0). These differences in fascicle length and pennation angle persisted throughout the 4 weeks after the injury (P < 0.008). Muscle thickness changes were not detected at any of the post-injury visits (difference < 4%, P > 0.04). Echo intensity of the injured limb was 8% lower at the presentation of the injury and 11% lower (P = 0.008) than the contralateral muscle at 2 weeks following injury (P < 0.001) but returned to within 1% by 4 weeks (P = 0.393). Our results suggest that Achilles tendon ruptures elicit rapid changes in the configuration and quality of the medial gastrocnemius, which may explain long-term functional deficits.

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Gastrocnemius fascicles are shorter and more pennate throughout the first month following acute Achilles tendon rupture

PeerJ ◽

10.7717/peerj.6788 ◽

2019 ◽

Vol 7 ◽

pp. e6788 ◽

Cited By ~ 5

Author(s):

Todd J. Hullfish ◽

Kathryn M. O’Connor ◽

Josh R. Baxter

Keyword(s):

Achilles Tendon ◽

Muscle Thickness ◽

Pennation Angle ◽

Medial Gastrocnemius ◽

Ultrasound Images ◽

Echo Intensity ◽

Post Injury ◽

Fascicle Length ◽

Clinical Visit ◽

Tendon Ruptures

The purpose of this study was to characterize the short-term effects of Achilles tendon ruptures on medial gastrocnemius. We hypothesized that the fascicles of the medial gastrocnemius muscle of the injured Achilles tendon would be shorter and more pennate immediately following the injury and would persist throughout 4 weeks post-injury. B-mode longitudinal ultrasound images of the medial gastrocnemius were acquired in 10 adults who suffered acute Achilles tendon ruptures and were treated non-operatively. Ultrasound images were acquired during the initial clinical visit following injury as well as 2 and 4 weeks following this initial clinical visit. Resting muscle structure was characterized by measuring fascicle length, pennation angle, muscle thickness, and muscle echo intensity in both the injured and contralateral (control) limbs. Fascicle length was 15% shorter (P < 0.001) and pennation angle was 21% greater (P < 0.001) in the injured muscle compared to the uninjured (control) muscle at the presentation of injury (week 0). These differences in fascicle length persisted through 4 weeks after injury (P < 0.002) and pennation angle returned to pre-injury levels. Muscle thickness changes were not detected at any of the post-injury visits (difference < 4%, P > 0.026). Echo intensity of the injured limb was 8% lower at the presentation of the injury but was not different compared to the contralateral muscle at 2 and 4 weeks post-injury. Our results suggest that Achilles tendon ruptures elicit rapid changes in the configuration of the medial gastrocnemius, which may explain long-term functional deficits.

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The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00282 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0028

Author(s):

Jonathan Kaplan ◽

Jeffery Hillam ◽

Amiethab Aiyer ◽

Niall Smyth

Keyword(s):

Diabetes Mellitus ◽

Postoperative Complications ◽

Achilles Tendon ◽

Power Analysis ◽

Tendon Rupture ◽

Surgical Repair ◽

Achilles Tendon Rupture ◽

The United States ◽

Foot And Ankle ◽

Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

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Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors77113 ◽

2021 ◽

Vol 9 (4) ◽

pp. 465-470

Author(s):

Saad Andaloussi

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Skin Wound ◽

Plantaris Tendon ◽

First Case ◽

Tendon Ruptures ◽

Post Traumatic

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

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Ultrasonographic Classification of Achilles Tendon Ruptures as a Rationale for Individual Treatment Selection

ISRN Orthopedics ◽

10.5402/2011/869703 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Michael H. Amlang ◽

Hans Zwipp ◽

Adina Friedrich ◽

Adam Peaden ◽

Alfred Bunk ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Individual Treatment ◽

Reliable Instrument ◽

Tendon Ruptures ◽

Selection For ◽

Sonographic Classification

Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture. Materials and Methods. From January 1, 2000 to December 31, 2005, 273 patients who suffered from a complete subcutaneous rupture of the Achilles tendon (ASR) were clinically and sonographically evaluated. The sonographic classification was organized according to the location of the rupture, the contact of the tendon ends, and the structure of the interposition between the tendon ends. Results. In 266 of 273 (97.4%) patients the sonographic classification of the rupture of the Achilles tendon was recorded. Type 1 was detected in 54 patients (19.8%), type 2a in 68 (24.9%), type 2b in 33 (12.1%), type 3a in 20 (7.3%), type 3b in 61 (22.3%), type 4 in 20 (7.3%), and type 5 in 10 (3.7%). Of the patients with type 1 and fresh ASR, 96% () were treated nonoperative-functionally, and 4% () were treated by percutaneous suture with the Dresden instrument (pDI suture). Of the patients classified as type 2a with fresh ASR, 31 patients (48%) were treated nonoperatively-functionally and 33 patients (52%) with percutaneous suture with the Dresden instrument (pDI suture). Of the patients with type 3b and fresh ASR, 94% () were treated by pDI suture and 6% () by open suture according to Kirchmayr and Kessler. Conclusion. Unlike the clinical classification of the Achilles tendon rupture, the sonographic classification is a guide for deriving a graded and differentiated therapy from a broad spectrum of treatments.

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Seasonal Variation of Achilles Tendon Injury

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00179 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0017

Author(s):

Jon-Michael Caldwell ◽

Harry Lightsey ◽

Hasani Swindell ◽

Justin Greisberg ◽

J. Turner Vosseller

Keyword(s):

Seasonal Variation ◽

Achilles Tendon ◽

Tendon Rupture ◽

Seasonal Pattern ◽

Achilles Tendon Rupture ◽

Tendon Injury ◽

Categorical Variables ◽

Continuous Variables ◽

Significant Difference ◽

Tendon Ruptures

Category: Sports Introduction/Purpose: Achilles tendon ruptures are increasingly common injuries. There are several known risk factors for Achilles tendon rupture, although little is reported on the seasonal variation of the incidence of these injuries. Of the few studies in the literature touching on this question, the results have been varied. We sought to determine if there is any seasonal pattern of Achilles tendon ruptures. Knowledge of such a seasonal pattern could be advantageous for patient education, risk assessment, and ultimately prevention of these injuries. Methods: We queried billing records for CPT codes 27650, 27652, and 27654 as well as ICD diagnosis codes 727.67, 845.09, and S86.01x pertaining to Achilles tendon injury, repair, and reconstruction. Charts were screened and included if the patient suffered an acute Achilles tendon rupture on a known date. Charts were excluded if the patient had a chronic Achilles tear or underwent reconstruction or debridement for tendonitis, Haglunds deformity, tendon laceration, or any other indication aside from acute rupture. Data was analyzed using a chi-squared test for categorical variables, binomial tests for dichotomous variables and Mann-Whitney-U or Welch t-test for continuous variables. Significance was set at p < 0.05. Results: Our search yielded 499 cases with 245 meeting inclusion criteria. Sixty-six percent (66%) of injuries were identified as sports-related while 34% were non-sports related. When stratified by month, significant peaks occurred in April and July (p = .036, .011 respectively) with significantly fewer injuries occurring in October through December (p = 0.049). The highest rate of injury was seen in Spring (p = .015) and the lowest was seen in Fall (p < .001). There was no significant difference between seasons when only the non-sports related injuries were considered. Basketball was the most common sport involved (n=78) accounting for 51% of injuries (p < .001), followed by soccer and tennis. There was no significant variation between seasons in any particular sport. Conclusion: There was significant seasonal variation in the incidence of Achilles tendon ruptures. Both sports and non-sports-related injuries followed a similar pattern, with most injuries occurring during the Spring and Summer and fewer during Fall and Winter. This increase corresponds to the increase in activity in the recreational athlete population in the region which is often preceded by a time of relative inactivity. Our study confirms that the deconditioned athlete is at particularly elevated risk for Achilles tendon rupture during the Spring season when abrupt increases in sporting activity are common. Targeted education and prevention efforts could help mitigate this risk.

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Subcutaneous Achilles tendon rupture in an eighty-year-old female with an absence of risk factors

Orthopedic Reviews ◽

10.4081/or.2010.e11 ◽

2010 ◽

Vol 2 (1) ◽

pp. 11

Author(s):

Motoki Sonohata ◽

Tsutomu Okamoto ◽

Kazuyoshi Uchihashi ◽

Tsutomu Motooka ◽

Hirofumi Tanaka ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Case Reports ◽

Achilles Tendon Rupture ◽

Treatment Protocol ◽

The Elderly ◽

Clinical Results ◽

Level Of Activity ◽

Healthy Female ◽

Tendon Ruptures

Achilles tendon ruptures rarely occur in patients over 80 years of age. However, it is unclear what treatment, surgical or conservative, is suitable for such an Achilles tendon rupture in the elderly. In addition, the clinical results of an Achilles tendon rupture in the elderly are disappointing. We report here the case of a subcutaneous Achilles tendon rupture in an eighty-year-old, healthy female, who returned to her previous level of activity following surgical treatment. Additional case reports of other instances of successful treatment are needed to help establish the optimal treatment protocol for an Achilles tendon rupture in the elderly.

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