Tendon lengthening after achilles tendon rupture–passive effects on the ankle joint in a cadaveric pilot study simulating weight bearing

• Published in: Injury 2020-02, Vol.51 (2), p.532-536
• Main Authors: Williamson, Patrick, M., Pennings, Jan, PH, Harlow, Ethan, Hanna, Philip, Lechtig, Aron, Okajima, Stephen, Biggane, Peter, Nasr, Michael, Zurakowski, David, Duggal, Naven, Nazarian, Ara
• Format: Article
• Language: English
• Subjects: Achilles tendon; Cadaver; Cadaveric; Kinetics; Lower leg; Tendon lengthening
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.10.024

•There is no consensus on the optimal treatment for Achilles tendon ruptures.•Achilles tendon lengthening after conservative treatment may alter ankle kinetics.•This study uses a cadaveric model that simulates static weight bearing to explore the effect of a lengthened Achilles tendon on ankle joint load distribution.•Achilles lengthening does not significantly change contact pressures of the ankle joint in this model.•Further studies are needed to address the effects of Achilles tendon lengthening on the ankle and elucidate the long-term clinical outcomes. In recent years, primary Achilles tendon ruptures have increased due to the aging population's participation in physically demanding activities. These injuries commonly occur during recreational sports and frequently lead to a long-term reduction in activity despite treatment. Non-operative methods of treatment for Achilles tendon ruptures may result in the Achilles healing in a lengthened position compared to the pre-injury state. This study uses a cadaveric model that simulates static weight bearing to explore the effect of a lengthened Achilles tendon on ankle joint load distribution. Five lower limb cadaveric specimens were placed on a custom jig, where a 334 N (75 lb) load was applied at the femoral head, and the foot was supported against a plate to simulate static double-leg stance. A pressure mapping sensor was inserted into the ankle joint. A percutaneous triple hemiresection tendo-Achilles lengthening procedure (Hoke procedure) was performed on each specimen to simulate tendon lengthening after conservative treatment. Contact pressure, peak pressure, and center-of-pressure were measured for native and tendon-lengthened conditions. Tendon rupture did not significantly alter average contact pressure, peak contact pressures, or center-of-pressure in the ankle joint compared with native tendon. Achilles lengthening does not significantly change contact pressures of the ankle joint in this model . This result suggests that the passive restraint on ankle joint translation imposed by the Achilles tendon is minimal without muscle activation.