Achilles Tendon Elastic Properties Remain Decreased in Long Term After Rupture

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2017 Nov 18

PMID 29147741

Citations 22

Authors

B Frankewycz

A Penz

J Weber

N P da Silva

F Freimoser

R Bell

M Nerlich

E M Jung

D Docheva

C G Pfeifer

Affiliations

Soon will be listed here.

Abstract

Purpose: Rupture of the Achilles tendon results in inferior scar tissue formation. Elastography allows a feasible in vivo investigation of biomechanical properties of the Achilles tendon. The purpose of this study is to investigate the biomechanical properties of healed Achilles tendons in the long term.

Materials And Methods: Patients who suffered from Achilles tendon rupture were recruited for an elastographic evaluation. Unilateral Achilles tendon ruptures were included and scanned in the mid-substance and calcaneal insertion at least 2 years after rupture using shear wave elastography. Results were compared to patients' contralateral non-injured Achilles tendons and additionally to a healthy population. Descriptive statistics, reliability analysis, and correlation analysis with clinical scores were performed.

Results: Forty-one patients were included in the study with a mean follow-up-time of 74 ± 30; [26-138] months after rupture. Significant differences were identified in shear wave elastography in the mid-substance of healed tendons (shear wave velocity 1.2 ±1.5 m/s) compared to both control groups [2.5 ±1.5 m/s (p < 0.01) and 2.8 ±1.6 m/s (p < 0.0001) contralateral and healthy population, respectively]. There was no correlation between the measurements and the clinical outcome.

Conclusions: This study shows that the healed Achilles tendon after rupture has inferior elastic properties even after a long-term healing phase. Differences in elastic properties after rupture mainly originate from the mid-substance of the Achilles tendon, in which most of the ruptures occur. Elastographic results do not correspond with subjective perception. Clinically, sonoelastographical measurements of biomechanical properties can be useful to provide objective insights in tendon recovery.

Citing Articles

Ultrasound Elastography Assessment of Knee Intra-Articular Adhesions at Varying Knee Angles.

Ye J, Peng L, Ding A, Chen S, Cai B, Yao Y Bioengineering (Basel). 2024; 11(7).

PMID: 39061788 PMC: 11274046. DOI: 10.3390/bioengineering11070706.

The role of mechanotransduction in tendon.

Nakamichi R, Asahara H J Bone Miner Res. 2024; 39(7):814-820.

PMID: 38795012 PMC: 11301520. DOI: 10.1093/jbmr/zjae074.

Unraveling the link: locomotor activity exerts a dual role in predicting Achilles tendon healing and boosting regeneration in mice.

Faydaver M, El Khatib M, Russo V, Rigamonti M, Raspa M, Di Giacinto O Front Vet Sci. 2024; 10:1281040.

PMID: 38179329 PMC: 10764449. DOI: 10.3389/fvets.2023.1281040.

Early Tendon Morphology as a Biomarker of Long-term Patient Outcomes After Surgical Repair of Achilles Tendon Rupture: A Prospective Cohort Study.

Saarensilta A, Aufwerber S, Silbernagel K, Ackermann P Orthop J Sports Med. 2023; 11(11):23259671231205326.

PMID: 37941888 PMC: 10629330. DOI: 10.1177/23259671231205326.

Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study.

Wu C, Xiong C, Bai L, Chen S, Yan Y, Wang L Chin J Traumatol. 2023; 26(6):323-328.

PMID: 37940448 PMC: 10755773. DOI: 10.1016/j.cjtee.2023.10.002.

References

Docheva D, Muller S, Majewski M, Evans C . Biologics for tendon repair. Adv Drug Deliv Rev. 2014; 84:222-39. PMC: 4519231. DOI: 10.1016/j.addr.2014.11.015. View

Nierhoff J, Chavez Ortiz A, Herrmann E, Zeuzem S, Friedrich-Rust M . The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol. 2013; 23(11):3040-53. DOI: 10.1007/s00330-013-2927-6. View

Zhang L, Wan W, Wang Y, Jiao Z, Zhang L, Luo Y . Evaluation of Elastic Stiffness in Healing Achilles Tendon After Surgical Repair of a Tendon Rupture Using In Vivo Ultrasound Shear Wave Elastography. Med Sci Monit. 2016; 22:1186-91. PMC: 4835154. DOI: 10.12659/MSM.895674. View

Dillman J, Chen S, Davenport M, Zhao H, Urban M, Song P . Superficial ultrasound shear wave speed measurements in soft and hard elasticity phantoms: repeatability and reproducibility using two ultrasound systems. Pediatr Radiol. 2014; 45(3):376-85. PMC: 4346477. DOI: 10.1007/s00247-014-3150-6. View

Rettig A, Liotta F, Klootwyk T, Porter D, Mieling P . Potential risk of rerupture in primary achilles tendon repair in athletes younger than 30 years of age. Am J Sports Med. 2004; 33(1):119-23. DOI: 10.1177/0363546504268720. View

Van Bergen C, Sierevelt I, Hoogervorst P, Waizy H, van Dijk C, Becher C . Translation and validation of the German version of the foot and ankle outcome score. Arch Orthop Trauma Surg. 2014; 134(7):897-901. DOI: 10.1007/s00402-014-1994-8. View

Attia D, Schoenemeier B, Rodt T, Negm A, Lenzen H, Lankisch T . Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med. 2015; 36(6):603-10. DOI: 10.1055/s-0041-107971. View

Lohrer H, Nauck T . Cross-cultural adaptation and validation of the VISA-A questionnaire for German-speaking achilles tendinopathy patients. BMC Musculoskelet Disord. 2009; 10:134. PMC: 2776582. DOI: 10.1186/1471-2474-10-134. View

Arya S, Kulig K . Tendinopathy alters mechanical and material properties of the Achilles tendon. J Appl Physiol (1985). 2009; 108(3):670-5. DOI: 10.1152/japplphysiol.00259.2009. View

10.

Chen T, Rozen W, Pan W, Ashton M, Richardson M, Taylor G . The arterial anatomy of the Achilles tendon: anatomical study and clinical implications. Clin Anat. 2009; 22(3):377-85. DOI: 10.1002/ca.20758. View

11.

Thiele M, Madsen B, Procopet B, Hansen J, Moller L, Detlefsen S . Reliability Criteria for Liver Stiffness Measurements with Real-Time 2D Shear Wave Elastography in Different Clinical Scenarios of Chronic Liver Disease. Ultraschall Med. 2016; 38(6):648-654. DOI: 10.1055/s-0042-108431. View

12.

Ying M, Yeung E, Li B, Li W, Lui M, Tsoi C . Sonographic evaluation of the size of Achilles tendon: the effect of exercise and dominance of the ankle. Ultrasound Med Biol. 2003; 29(5):637-42. DOI: 10.1016/s0301-5629(03)00008-5. View

13.

Bleakney R, Tallon C, Wong J, Lim K, Maffulli N . Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med. 2002; 12(5):273-8. DOI: 10.1097/00042752-200209000-00003. View

14.

LaCroix A, Duenwald-Kuehl S, Lakes R, Vanderby Jr R . Relationship between tendon stiffness and failure: a metaanalysis. J Appl Physiol (1985). 2013; 115(1):43-51. PMC: 3727010. DOI: 10.1152/japplphysiol.01449.2012. View

15.

Chen X, Cui L, He P, Shen W, Qian Y, Wang J . Shear wave elastographic characterization of normal and torn achilles tendons: a pilot study. J Ultrasound Med. 2013; 32(3):449-55. DOI: 10.7863/jum.2013.32.3.449. View

16.

Eliasson P, Couppe C, Lonsdale M, Svensson R, Neergaard C, Kjaer M . Ruptured human Achilles tendon has elevated metabolic activity up to 1 year after repair. Eur J Nucl Med Mol Imaging. 2016; 43(10):1868-77. DOI: 10.1007/s00259-016-3379-4. View

17.

Raikin S, Garras D, Krapchev P . Achilles tendon injuries in a United States population. Foot Ankle Int. 2013; 34(4):475-80. DOI: 10.1177/1071100713477621. View

18.

DeWall R, Slane L, Lee K, Thelen D . Spatial variations in Achilles tendon shear wave speed. J Biomech. 2014; 47(11):2685-92. PMC: 4125528. DOI: 10.1016/j.jbiomech.2014.05.008. View

19.

Mark-Christensen T, Troelsen A, Kallemose T, Barfod K . Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc. 2014; 24(6):1852-9. DOI: 10.1007/s00167-014-3180-5. View

20.

Frank C, McDonald D, Shrive N . Collagen fibril diameters in the rabbit medial collateral ligament scar: a longer term assessment. Connect Tissue Res. 1997; 36(3):261-9. DOI: 10.3109/03008209709160226. View