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Achilles tendon elongation after acute rupture: is it a problem? A systematic review

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

Abstract

Purpose

Rupture of the Achilles tendon (AT) is a common injury. Strength deficits may persist over the long term, possibly owing to elongation of the tendon or inferior mechanical properties. This study aimed to provide a systematic review of the literature on the prevalence and consequences of tendon elongation in patients after acute AT rupture treatment. It was hypothesized that an elongated tendon would be associated with a worse clinical outcome.

Methods

The databases for MEDLINE, CENTRAL and Web of Science were searched. Clinical studies related to AT rupture reporting tendon elongation and clinical or functional outcomes, with a minimum follow-up of 6 months, were eligible for inclusion. Only studies testing for statistical correlations (SCs) between AT elongation and other outcomes were eligible, with the exception of biomechanical studies in which statistically significant AT elongation was found to be a generalized finding in the study group. For these studies to be eligible, the study group had to be compared with a healthy control group, or the injured limb compared with the uninjured limb, regarding biomechanical parameters.

Results

Twenty-eight papers were selected for inclusion. Mean AT elongation measured with imaging techniques ranged from 0.15 to 3.1 cm (n = 17). Ten studies investigated SCs with Patient Reported Outcome Measures (PROMs), in which two found SCs with tendon elongation. Five studies reported strength and power evaluations and their correlation with AT elongation, with two having found SCs between decreased strength and tendon elongation. In ten studies reporting data on biomechanical tests, nine found influence of tendon elongation. In this group, four out of five studies found SCs with biomechanical parameters.

Conclusion

Fair evidence of the influence of tendon elongation in biomechanical parameters was found. In a general population, evidence of a detrimental effect of tendon elongation on PROMs or functional strength at follow-up was not found in this review.

Level of evidence

Level IV.

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Abbreviations

AT:

Achilles tendon

ATR:

Achilles tendon rupture

ATRA:

Achilles Tendon Resting Angle

ATRS:

Achilles Tendon Total Rupture Score

FAOS:

Foot and Ankle Outcome Score

HRH:

Heel-rise height

HRW:

Heel-rise work

iEMG:

Integrated EMG

MCC:

Maximum calf circumference

MRI:

Magnetic resonance imaging

MV:

Muscle volume

PAS:

Physical activity scale

PROMs:

Patient reported outcome measures

QUIPs:

Quality in Prognosis Studies

ROM:

Range of motion

SCs:

Statistical correlations

TAS:

Tegner activity scale

US:

Ultrasound

VAS:

Visual analog scale

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Acknowledgements

Thanks to Portuguese Foundation for Science and Technology for iBB funding (UID/BIO/04565/2020).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital de Sant’Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal

    Pedro Diniz, Jácome Pacheco & Francisco Guerra-Pinto

  2. Department of Bioengineering and iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal

    Pedro Diniz & Frederico Castelo Ferreira

  3. Fisiogaspar, Lisbon, Portugal

    Pedro Diniz

  4. Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal

    Hélder Pereira

  5. Ripoll y De Prado Sports Clinic: FIFA Medical Centre of Excellence, Murcia, Madrid, Spain

    Hélder Pereira

  6. University of Minho ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal

    Hélder Pereira

  7. Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Gino Kerkhoffs

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Contributions

PD designed the systematic review protocol, screened and selected studies, extracted and analyzed data, drafted the manuscript. JP screened and selected studies, extracted and analyzed data. FGP and FF revised the manuscript. HP and GK designed the systematic review protocol, supervised the selection of studies and revised the manuscript. All authors read and approved the final manuscript.

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Diniz, P., Pacheco, J., Guerra-Pinto, F. et al. Achilles tendon elongation after acute rupture: is it a problem? A systematic review. Knee Surg Sports Traumatol Arthrosc 28, 4011–4030 (2020). https://doi.org/10.1007/s00167-020-06010-8

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