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Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy

Abstract

Purpose

The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed.

Methods

In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment. Demographic parameters, time off work, maximum calf circumference and clinical scores (ATRS, Hannover, AOFAS) were evaluated. Muscle volume and cross-sectional area of the calf and AT length were measured on MR images and were compared between groups and to each patient’s healthy contralateral leg.

Results

Reduced muscle volume was found across all groups with a higher muscle volume in the conservative (729.9 ± 130.3 cm3) compared to the percutaneous group (675.9 ± 207.4 cm3, p = 0.04). AT length was longer in the affected leg (198.4 ± 24.1 vs. 180.6 ± 25.0 mm, p < 0.0001) without difference in subgroup analysis. Clinically measured ankle dorsiflexion showed poor correlation with AT length (R 2 = 0.07, p = 0.008). Muscle volume strongly correlated with the cross-sectional area (R 2 = 0.6, p < 0.0001) but showed a weak correlation with the Hannover score (R 2 = 0.08, p = 0.048). Maximum calf circumference correlated with muscle volume (R 2 = 0.42, p < 0.0001).

Conclusions

No significant difference between the treatment groups was found in muscle volume, AT length, clinical measures or days off work. Cross-sectional area and maximum calf circumference are cost-effective measurements and a good approximation of muscle volume and can thus be used in a clinical setting while clinical dorsiflexion should not be used.

Level of evidence

III.

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Acknowledgments

We thank Tanja Haas for her MRI examinations. We thank Professor Beat Hintermann and Dr. Martin Majewski, for their contribution in patient acquisition. The lead centre of this study was the University Hospital Basel, Basel, Switzerland. This multicentre study was funded by a grant from the Swiss National Accident Insurance Company (SUVA), Lucerne, Switzerland. Each author certifies that his or her institution has approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.

Conflict of interest

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

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Authors and Affiliations

  1. Orthopaedic Department, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Claudio Rosso, Patrick Vavken, Caroline Polzer, Daniel M. Buckland, Andreas Marc Müller & Victor Valderrabano

  2. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel M. Buckland

  3. Harvard School of Public Health, Boston, MA, USA

    Patrick Vavken

  4. Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA

    Patrick Vavken

  5. Rennbahn Clinic, Muttenz, Switzerland

    Lukas Weisskopf

  6. Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland

    Ueli Studler

  7. Cantons Hospital Fribourg, Fribourg, Switzerland

    Marc Lottenbach

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  1. Claudio Rosso
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Correspondence to Claudio Rosso.

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Rosso, C., Vavken, P., Polzer, C. et al. Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc 21, 1369–1377 (2013). https://doi.org/10.1007/s00167-013-2407-1

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  • DOI: https://doi.org/10.1007/s00167-013-2407-1

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