Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 7, pp 2080–2087 | Cite as

Achilles tendon elastic properties remain decreased in long term after rupture

  • B. FrankewyczEmail author
  • A. Penz
  • J. Weber
  • N. P. da Silva
  • F. Freimoser
  • R. Bell
  • M. Nerlich
  • E. M. Jung
  • D. Docheva
  • C. G. Pfeifer



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.


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.


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.


Achilles tendon Achilles tendon rupture Shear wave elastography Elastic properties Biomechanical properties Tendon biomechanics 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no competing interest.

Ethical approval

The study was performed after approval of the university’s ethical review committee (University of Regensburg, AZ 15-101-0019).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • B. Frankewycz
    • 1
    • 3
    Email author
  • A. Penz
    • 1
  • J. Weber
    • 1
  • N. P. da Silva
    • 2
  • F. Freimoser
    • 1
  • R. Bell
    • 3
  • M. Nerlich
    • 1
  • E. M. Jung
    • 2
  • D. Docheva
    • 1
  • C. G. Pfeifer
    • 1
  1. 1.Department of Trauma Surgery and Laboratory of Experimental Trauma SurgeryRegensburg University Medical CenterRegensburgGermany
  2. 2.Department of RadiologyRegensburg University Medical CenterRegensburgGermany
  3. 3.Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaUSA

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