Long-term biomechanical outcomes after Achilles tendon ruptures

  • Claudio RossoEmail author
  • Daniel M. Buckland
  • Caroline Polzer
  • Patrick Sadoghi
  • Reinhard Schuh
  • Lukas Weisskopf
  • Patrick Vavken
  • Victor Valderrabano



The ideal treatment for Achilles tendon ruptures is still unknown. Biomechanical were correlated to radiological and clinical parameters to study outcomes.


In this retrospective, assessor-blinded multi-centre cohort study, 52 patients with unilateral Achilles tendon rupture were assessed, each at least 3 years after injury. Patients underwent open surgery, percutaneous surgery or non-surgical treatment of Achilles tendon rupture. Both legs underwent plantar pressure distribution and isokinetic measures. Demographic parameters, maximum calf circumference (MCC) and clinical scores (American Orthopaedic Foot and Ankle Society, Achilles tendon rupture score, Hannover) were also evaluated. Complications were not assessed.


Peak plantar flexion torque (PPFT) was significantly weaker on the treated side compared to the untreated leg [80.4 ± 29.7 Nm (mean ± SD) vs. 92.1 ± 27.4 Nm, p < 0.0001]. PPFT and push-off force (POFF) were not different between treatment groups nor was there a leg difference in POFF alone. There was only a weak correlation of clinical scores and PPFT or POFF, respectively. MCC correlated significantly with both PPFT (R 2 = 0.21, p = 0.01) and POFF (R 2 = 0.29, p < 0.0001). POFF appeared to be a predictor of PPFT (R 2 = 0.31, p < 0.0001). Open surgery outperformed non-surgical treatment in terms of centre-of-pressure line (p = 0.007), torque per muscle volume (p = 0.04) and relative POFF per body weight (p = 0.02) and relative in side comparison (p = 0.03).


Clinical scores do not predict biomechanical outcomes. Clinically measured MCC is a good predictor of PPFT and POFF and can easily be used in clinical practice. Relative POFF in side comparison as well as per body weight favours surgical treatment.


Peak plantar flexion torque COP Achilles tendon rupture Plantar pressure distribution (PPD) 



We thank Xavier Kaelin MSc and Marlene Mauch PhD for their biomechanical studies and their steady effort in patient examinations. From the Department of Radiology, we would like to thank Dr. Ueli Studler for his help in the radiologic workup and Tanja Haas for her MRI examinations. We thank Professor Beat Hintermann, Dr. Marc Lottenbach and Dr. Martin Majewski, for their contribution in patient acquisition. The lead centre of this study was the University Hospital Basel, Basel, Switzerland. This multi-centre study was funded by a grant from the Swiss National Accident Insurance Company (SUVA), Lucerne, Switzerland. DMB is funded by a post-doctoral fellowship from the Whitaker International Program.

Conflict of interest

Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Claudio Rosso
    • 1
    Email author
  • Daniel M. Buckland
    • 1
  • Caroline Polzer
    • 1
  • Patrick Sadoghi
    • 5
  • Reinhard Schuh
    • 6
  • Lukas Weisskopf
    • 4
  • Patrick Vavken
    • 1
    • 2
    • 3
  • Victor Valderrabano
    • 1
  1. 1.Orthopaedic Department, University Hospital BaselUniversity of BaselBaselSwitzerland
  2. 2.Harvard Center for Population and Development StudiesHarvard School of Public HealthBostonUSA
  3. 3.Orthopedics, Harvard Medical SchoolChildren’s Hospital BostonBostonUSA
  4. 4.Rennbahn ClinicMuttenzSwitzerland
  5. 5.Department of Orthopaedic SurgeryMedical University GrazGrazAustria
  6. 6.Department of Orthopaedics, Vienna General HospitalMedical University of ViennaViennaAustria

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