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Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury
Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics, Department of Orthopaedics.
2017 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 13, p. 3060-3068Article in journal (Refereed) Published
Abstract [en]

Background: It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term.

Purpose: To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height.

Methods: Seventeen patients with less than 15% (<15% group) and 17 patients with greater than 30% (>30% group) side-toside difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side divided by Healthy Side x 3 100) was calculated for side differences.

Results: The.30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the <15% group at a mean of 6 years after ATR (LSI, 70%-149% and 84%-106%, respectively; P =.010-.024). The.30% group, compared with the <5% group, also had significantly lower values in heel-rise height (LSI, 72% and 95%, respectively; P<. 001) and heel-rise work (LSI, 58% and 91%, respectively; P<. 001) and significantly larger side-to-side difference in tendon length (114% and 106%, respectively; P =.012). Achilles tendon length correlated with ankle kinematic variables (r = 0.38-0.44; P =.015-.027) whereas heel-rise work correlated with kinetic variables (r = 20.57 to 0.56; P =.001-.047). LSI tendon length correlated negatively with LSI heel-rise height (r = 20.41; P =.018). No differences were found between groups in patient-reported outcome (P =.143-.852).

Conclusion: Height obtained during the single-leg standing heel-rise test performed 1 year after ATR related to the long-term ability to regain normal ankle biomechanics. Minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping.

Place, publisher, year, edition, pages
Sage Publications, 2017. Vol. 45, no 13, p. 3060-3068
Keywords [en]
Achilles tendon rupture, ankle, biomechanics, heel-rise test
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:hj:diva-40489DOI: 10.1177/0363546517717698ISI: 000414146500022PubMedID: 28783473Scopus ID: 2-s2.0-85032961010OAI: oai:DiVA.org:hj-40489DiVA, id: diva2:1220720
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-10-16Bibliographically approved

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