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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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°(SD1.28) larger, ATRA 8.1°(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.

Level of evidence

II.

Clinical trials identifier

NCT02760784.

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Abbreviations

aATR:

Acute Achilles tendon rupture

ATRA:

Achilles tendon resting angle

ATRS:

Achilles tendon total rupture score

HRH:

Heel raise height

LSI:

Limb symmetry index

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Acknowledgements

The authors thank Thomas Kallemose for his statistical analysis.

Funding

The project was funded by Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark, with no external funding, or involvement.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark

    Rasmus Kastoft, Kristoffer Barfod & Jeannette Ø. Penny

  2. Laboratory of Human Movement Analysis, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager, Hvidovre, Denmark

    Jesper Bencke & Merete B. Speedtsberg

  3. Department of Orthopaedic Surgery, Zealand University Hospital, Koege, Denmark

    Jeannette Ø. Penny

  4. Department of Radiology, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark

    Sanja Bay Hansen

Authors
  1. Rasmus Kastoft
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  2. Kristoffer Barfod
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Correspondence to Rasmus Kastoft.

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The authors have no conflict of interest to declare.

Ethical approval

Local ethics committee reference number: 16015461.

Informed consent

Informed consent was obtained from each trial participant.

Disclosures

K. Barfod: Consultancy for DJO.

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Kastoft, R., Barfod, K., Bencke, J. et al. 1.7 cm elongated Achilles tendon did not alter walking gait kinematics 4.5 years after non-surgical treatment. Knee Surg Sports Traumatol Arthrosc 30, 3579–3587 (2022). https://doi.org/10.1007/s00167-022-06874-y

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