Skip to main content
SpringerLink
Log in

Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post-rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment.

Method

The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 months post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during overground walking.

Results

Achilles lengths at 6 and 12 months post-surgery were significantly longer (p < 0.05) on the involved side compared to the uninvolved side, but there were no side-to-side differences in the healthy controls. The integrated EMG (iEMG) of the involved side was significantly higher than the uninvolved side in the lateral gastrocnemius at 6 months and for the medial gastrocnemius at 12 months in the patients with Achilles tendon rupture; no side-to-side difference was found in the healthy controls. The triceps surae muscles’ activations were fair to moderately correlated to the Achilles lengths (0.38 < r < 0.52).

Conclusions

The increased Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength, an important treatment goal appears to be to minimize tendon elongation.

Level of evidence

Prognostic prospective case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Costa M (2006) The effect of Achilles tendon lengthening on ankle dorsiflexion: a cadaver study. Foot Ankle Int 27:414–417

    PubMed  Google Scholar 

  2. Don R, Ranavolo A, Cacchio A, Serrao M, Costabile F, Iachelli M, Camerota F, Frascarelli M, Santilli V (2007) Relationship between recovery of calf-muscle biomechanical properties and gait pattern following surgery for Achilles tendon rupture. Clin Biomech 22:211–220

    Article  Google Scholar 

  3. Ferri A, Scaglioni G, Pousson M, Capodaglio P, Van Hoecke J, Narici MV (2003) Strength and power changes of the human plantar flexors and knee extensors in response to resistance training in old age. Acta Physiol Scand 177:69–78

    Article  CAS  PubMed  Google Scholar 

  4. Haggmark T, Eriksson E (1979) Hypotrophy of the soleus muscle in man after Achilles tendon rupture: discussion of findings obtained by computed tomography and morphologic studies. Am J Sport Med 7:121–126

    Article  CAS  Google Scholar 

  5. Horstmann T, Lukas C, Mayer F, Winter E, Ambacher T, Heitkamp H, Dickhuth H (2000) Isokinetic strength and strength endurance of lower limb musculature 10 years after Achilles tendon repair. Isokinet Exerc Sci 8:141–145

    Google Scholar 

  6. Kangas J, Pajala A, Ohtonen P, Leppilahti J (2007) Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sport Med 35:59–64

    Article  Google Scholar 

  7. Maganaris CN (2001) Force–length characteristics of in vivo human skeletal muscle. Acta Physiol Scand 172:279–285

    Article  CAS  PubMed  Google Scholar 

  8. Maquirriain J (2011) Achilles tendon rupture: avoiding tendon lengthening during surgical repair and rehabilitation. Yale J Biol Med 84:289–300

    PubMed Central  PubMed  Google Scholar 

  9. Mortensen NH, Saether J, Steinke H, Mikkelsen SS (1992) Separation of tendon ends after Achilles tendon repair: a prospective, randomized, multicenter study. Orthopedics 15:299–903

    Google Scholar 

  10. Mortensen NHM, Jensen PE (1999) Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. J Bone Joint Surg Am 81:983–990

    CAS  PubMed  Google Scholar 

  11. Mullaney MJ, McHugh MP, Tyler TF, Nicholas SJ, Lee SJ (2006) Weakness in end-range plantar flexion after Achilles tendon repair. Am J Sport Med 34:1120–1125

    Article  Google Scholar 

  12. Nilsson-Helander K, Thomeé R, Silbernagel KG, Grävare-Silbernagel K, Thomeé P, Faxén E, Eriksson BI, Karlsson J (2007) The Achilles tendon total rupture score (ATRS): development and validation. Am J Sport Med 35:421–426

    Article  Google Scholar 

  13. Olsson N, Nilsson-Helander K, Karlsson J, Eriksson BI, Thomée R, Faxén E, Silbernagel KG (2011) Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 19:1385–1393

    Article  PubMed  Google Scholar 

  14. Perotto AO, Delagi EF, Iazzetti J, Morrison D (2005) Anatomical guide for the electromyographer. Charles C Thomas Pub Ltd, Springfield, pp 152–168

    Google Scholar 

  15. Rees JD, Lichtwark GA, Wolman RL, Wilson AM (2008) The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. Rheumatology 47:1493–1497

    Article  CAS  PubMed  Google Scholar 

  16. Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794

    CAS  PubMed  Google Scholar 

  17. Schepull T, Kvist J, Andersson C, Aspenberg P (2007) Mechanical properties during healing of Achilles tendon ruptures to predict final outcome: a pilot Roentgen stereo photogrammetric analysis in 10 patients. BMC Musculoskelet Disord 8:116

    Article  PubMed Central  PubMed  Google Scholar 

  18. Silbernagel KG, Steele R, Manal K (2012) Deficits in heel-rise height and Achilles tendon elongation occur in patients recovering from an Achilles tendon rupture. Am J Sport Med 40:1564–1571

    Article  Google Scholar 

  19. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92:2767–2775

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the Swedish Research Council for its financial support. This work was also supported by NIH grant P30-GM103333.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. University of Delaware, 126 Spencer Lab, Newark, DE, 19716-3140, USA

    Stephen M. Suydam, Thomas S. Buchanan & Kurt Manal

  2. University of the Sciences, 600 S. 43rd Street, Philadelphia, PA, 19104, USA

    Karin Gravare Silbernagel

Authors
  1. Stephen M. Suydam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas S. Buchanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kurt Manal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karin Gravare Silbernagel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen M. Suydam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suydam, S.M., Buchanan, T.S., Manal, K. et al. Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 23, 868–874 (2015). https://doi.org/10.1007/s00167-013-2512-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2512-1

Keywords

Search

Navigation