Geremia Jeam Marcel, Bobbert Maarten Frank, Casa Nova Mayra, Ott Rafael Duvelius, Lemos Fernando de Aguiar, Lupion Raquel de Oliveira, Frasson Viviane Bortoluzzi, Vaz Marco Aurélio
Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Faculty of Physical Education Sogipa, Porto Alegre, Brazil.
Faculty of Human Movement Sciences, Move Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands.
Clin Biomech (Bristol). 2015 Jun;30(5):485-92. doi: 10.1016/j.clinbiomech.2015.03.005. Epub 2015 Mar 11.
Acute ruptures of the Achilles tendon affect the tendon's structural and mechanical properties. The long-term effects of surgical repair on these properties remain unclear.
To evaluate effects of early mobilization versus traditional immobilization rehabilitation programs 2 years after surgical Achilles tendon repair, by comparing force-elongation and stress-strain relationships of the injured tendon to those of the uninjured tendon.
A group of males with previous Achilles tendon rupture (n=18) and a group of healthy male controls (n=9) participated. Achilles tendon rupture group consisted of patients that had received early mobilization (n=9) and patients that had received traditional immobilization with a plaster cast (n=9). Comparisons of tendon structural and mechanical properties were made between Achilles tendon rupture and healthy control groups, and between the uninjured and injured sides of the two rehabilitation groups in Achilles tendon rupture group. Ultrasound was used to determine bilaterally tendon cross-sectional area, tendon resting length, and tendon elongation as a function of torque during maximal voluntary plantar flexion. From these data, Achilles tendon force-elongation and stress-strain relationships were determined.
The Achilles tendon rupture group uninjured side was not different from healthy control group. Structural and mechanical parameters of the injured side were not different between the Achilles tendon rupture early mobilization and the immobilization groups. Compared to the uninjured side, the injured side showed a reduction in stress at maximal voluntary force, in Young's modulus and in stiffness.
Two years post-surgical repair, the Achilles tendon mechanical properties had not returned to the uninjured contralateral tendon values.
跟腱急性断裂会影响肌腱的结构和力学性能。手术修复对这些性能的长期影响尚不清楚。
通过比较受伤肌腱与未受伤肌腱的力-伸长和应力-应变关系，评估跟腱手术修复2年后早期活动与传统固定康复方案的效果。
一组既往有跟腱断裂的男性（n = 18）和一组健康男性对照组（n = 9）参与研究。跟腱断裂组包括接受早期活动的患者（n = 9）和接受传统石膏固定的患者（n = 9）。比较跟腱断裂组与健康对照组之间，以及跟腱断裂组中两个康复组的未受伤侧与受伤侧之间的肌腱结构和力学性能。使用超声双侧测定肌腱横截面积、肌腱静息长度以及最大自主跖屈时肌腱伸长随扭矩的变化。根据这些数据，确定跟腱的力-伸长和应力-应变关系。
跟腱断裂组的未受伤侧与健康对照组无差异。跟腱断裂早期活动组与固定组受伤侧的结构和力学参数无差异。与未受伤侧相比，受伤侧在最大自主力时的应力、杨氏模量和刚度均降低。
手术修复两年后，跟腱的力学性能尚未恢复到未受伤对侧肌腱的值。
