Costa Matthew L, Logan Karl, Heylings David, Donell Simon T, Tucker Keith
Orthopaedics, Clinical Sciences Building, Warwick Medical School, Coventry, UK.
Foot Ankle Int. 2006 Jun;27(6):414-7. doi: 10.1177/107110070602700605.
Tendon lengthening is an important cause of morbidity after Achilles tendon rupture. However, direct measurement of the tendon length is difficult. Ankle dorsiflexion has, therefore, been used as a surrogate measure on the assumption that it is the Achilles tendon that limits this movement. The aim of this investigation was to assess the relationship between Achilles tendon length and ankle dorsiflexion. The primary question was whether or not the Achilles tendon is the structure that limits ankle dorsiflexion. The secondary purpose was to quantify the relationship between Achilles tendon lengthening and dorsiflexion at the ankle joint.
Five cadaver specimens were dissected to expose the tendons and capsular tissue of the leg and hindfoot. Fixed bony reference points were used as markers for the measurements. In the first specimen, the Achilles tendon was intact and the other structures that may limit ankle dorsiflexion were sequentially divided. In the other specimens the Achilles tendon was lengthened by 1 cm intervals and the effect upon ankle dorsiflexion movement was recorded.
Division of the other tendons and the capsular tissue around the ankle joint did not affect the range of ankle dorsiflexion. When the Achilles was divided the foot could be dorsiflexed until the talar neck impinged upon the anterior aspect of the distal tibia. There was a mean increase of 12 degrees of dorsiflexion for each centimeter increase in tendon length.
The Achilles tendon is the anatomical structure that limits ankle dorsiflexion, even when the tendon is lengthened. There was a linear relationship between the length of the Achilles tendon and the range of ankle dorsiflexion in this cadaver model. Ankle dorsiflexion would appear to be a clinically useful indicator of tendon length.
跟腱延长是跟腱断裂后发病的一个重要原因。然而，直接测量肌腱长度很困难。因此，踝关节背屈被用作替代测量指标，其假设是跟腱限制了这种运动。本研究的目的是评估跟腱长度与踝关节背屈之间的关系。主要问题是跟腱是否是限制踝关节背屈的结构。次要目的是量化跟腱延长与踝关节背屈之间的关系。
解剖5具尸体标本，以暴露小腿和后足的肌腱及关节囊组织。使用固定的骨性参考点作为测量标记。在第一个标本中，跟腱完整，依次切断可能限制踝关节背屈的其他结构。在其他标本中，跟腱以1厘米的间隔延长，并记录对踝关节背屈运动的影响。
切断踝关节周围的其他肌腱和关节囊组织并不影响踝关节背屈范围。切断跟腱后，足部可背屈直至距骨颈撞击胫骨远端前方。肌腱长度每增加1厘米，背屈平均增加12度。
跟腱是限制踝关节背屈的解剖结构，即使肌腱延长时也是如此。在这个尸体模型中，跟腱长度与踝关节背屈范围之间存在线性关系。踝关节背屈似乎是肌腱长度的一个临床有用指标。
