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Early E-modulus of healing Achilles tendons correlates with late function: Similar results with or without surgery
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-3527-5488
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2012 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 22, no 1, 18-23 p.Article in journal (Refereed) Published
Abstract [en]

Non-operative treatment of Achilles tendon ruptures is associated with an increased risk of rerupture. We hypothesized that this is due to inferior mechanical properties during an early phase of healing, and performed a randomized trial, using a new method to measure the mechanical properties. Tantalum markers were inserted in the tendon stumps, and tendon strain at different loadings was measured by stereo-radiography (Roentgen stereophotogrammetric analysis) at 3, 7 and 19 weeks and 18 months after injury. Thirty patients were randomized to operative or non-operative treatment. The primary out-come variable was an estimate for the modulus of elasticity at 7 weeks. Strain per force, cross-sectional area and tendon elongation were also measured. The functional outcome variable was the heel-raise index after 18 months. There was no difference in the mean modulus of elasticity or other mechanical or functional variables between operative and non-operative treatments at any time-point, but strain per force at 7 and 19 weeks had a significantly larger variation in the non-operative group. This group, therefore, might contain more outliers with poor healing. The modulus of elasticity at 7 weeks correlated with the heel-raise index after 18 months in both treatment groups (r2=0.75; P=0.0001). This correlation is an intriguing finding.

Place, publisher, year, edition, pages
John Wiley and Sons , 2012. Vol. 22, no 1, 18-23 p.
Keyword [en]
achilles tendon rupture, tendon healing, biomechanics, modulus of elasticity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-75106DOI: 10.1111/j.1600-0838.2010.01154.xISI: 000298984300004OAI: oai:DiVA.org:liu-75106DiVA: diva2:504552
Note
Funding Agencies|Swedish Medical Research council||Swedish Center for Sports Medicine Research||King Gustav V and Queen Victoria Free Mason fund||Available from: 2012-02-21 Created: 2012-02-17 Last updated: 2017-12-07
In thesis
1. Stiffness of the healing human Achilles tendon
Open this publication in new window or tab >>Stiffness of the healing human Achilles tendon
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Achilles tendon ruptures in humans are followed by a long period of immobilisation, rehabilitation and limitations of physical activity and sometimes work also. This prolonged period probably leaves a marginal for improvement in the management of this injury. Animal studies have shown that there are several possibilities to influence and improve tendon healing.

The aim of this thesis was to find a way to examine the mechanical properties of the healing human Achilles tendon and, by using that method, to gain a better understanding of the tissue properties and healing process in these tendons. It was also our aim to use our knowledge from animal studies in an attempt to improve tendon healing in humans.

We developed a radiological method using radiostereophotogrammetric analysis (RSA) and computed tomography (CT), which enabled us to measure the stiffness of the healing Achilles tendon. The results of these measurements, as early as 7 weeks after injury correlated with the late clinical results in all studies. Clinical results were measured using a heel-raise test comparing the injured with the non-injured tendon. We could not find a significant difference in stiffness between patients treated surgically or non-surgically. Neither could we demonstrate that platelet-rich plasma improved the mechanical properties of the healing tendon or the clinical outcome, within the limits of the statistical power. In contrast, patients following a specific training programme with early tension loading of the tendon twice a day developed stiffer tendon tissue later in the healing process.

Since RSA is unsuitable for routine clinical use, we evaluated the possibility to use radiodensity findings from CT as a proxy for healing and its correlation to mechanical and clinical results. Density and mechanical properties correlated strongly when analysing all time points together, but only weakly at each particular point in time. Density may still be useful in describing mechanical properties at a later stage of repair, but this remains to be seen.

In conclusion, these studies show that early mechanical properties correlate to late clinical outcome and that the early use of daily tension loading sessions leads to an improvement in the mechanical properties of the tendon tissue.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 59 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1356
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91727 (URN)978-91-7519-674-9 (ISBN)
Public defence
2013-06-04, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2013-05-13Bibliographically approved

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Schepull, TorstenKvist, JoannaAspenberg, Per

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