Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden.
Orthop J Sports Med. 2013 Sep 20;1(4):2325967113504734. doi: 10.1177/2325967113504734. eCollection 2013 Sep.
Precise long-term assessment of movement and physical function following Achilles tendon rupture is required for the development and evaluation of treatment, including different regimens of physical therapy.
To assess intermediate-term (<10 years by conventional thinking) objective measures of physical function following Achilles tendon rupture treated nonsurgically and to compare these with self-reported measures of physical function.
Cross-sectional study; Level of evidence, 3.
Two to 5 years after Achilles tendon rupture, 9 women and 43 men (mean age, 49.2 years; range, 26-68 years) were assessed by physical examination, performance of 1-legged jumps, and 3-dimensional gait analysis (including calculation of muscle work). Self-reported scores for foot function (Achilles tendon rupture score) and level of physical activity were collected. Twenty age- and sex-matched controls were assessed in the same manner.
Physical examination of patients with the knee extended revealed 11.1° of dorsiflexion on the injured side and 9.2° on the uninjured side (P = .020), indicating gastrocnemius muscle lengthening. The 1-legged jump distance was shorter on the injured side (89.5 vs 96.2 cm; P < .001). Gait analysis showed higher peak dorsiflexion (14.3° vs 13.3°; P = .016) and lower concentric (positive) plantar flexor work (16.6 vs 19.9 J/kg; P = .001) in the ankle on the uninjured side. At the same time, eccentric (negative) dorsiflexor work was higher on the injured side (13.2 vs 11.9 J/kg; P = .010). Self-perceived foot function and physical activity were lower in patients than in healthy controls (mean Achilles tendon rupture score, 78.6 and 99.8, respectively).
Nonsurgically treated patients with Achilles tendon rupture showed signs of both anatomic and functional lengthening of the tendon. Attenuated muscle strength and function were present during walking as long as 2 to 5 years after rupture, as determined by 3-dimensional gait analysis. More extensive future studies involving patients having both surgical and nonsurgical treatment could provide additional valuable information.
对于跟腱断裂的治疗和评估，包括不同的物理治疗方案，需要对运动和身体功能进行精确的长期评估。
评估非手术治疗的跟腱断裂患者在中期（传统观念认为<10 年）的身体功能的客观指标，并将这些结果与自我报告的身体功能结果进行比较。
横断面研究；证据水平，3 级。
在跟腱断裂后 2 至 5 年，对 9 名女性和 43 名男性（平均年龄 49.2 岁；范围，26-68 岁）进行体格检查、单腿跳跃和三维步态分析（包括肌肉做功计算）。收集自我报告的足部功能（跟腱断裂评分）和身体活动水平评分。对 20 名年龄和性别匹配的对照组进行了相同的评估。
膝关节伸展时，患者的体格检查显示患侧背屈 11.1°，健侧背屈 9.2°（P =.020），提示腓肠肌延长。患侧单腿跳跃距离较短（89.5 对 96.2cm；P<0.001）。步态分析显示，健侧踝关节背屈峰值更高（14.3°对 13.3°；P=.016），而跖屈肌的向心（阳性）工作较低（16.6 对 19.9J/kg；P=.001）。与此同时，患侧的离心（阴性）背屈肌做功更高（13.2 对 11.9J/kg；P=.010）。患者的自我感知足部功能和身体活动能力均低于健康对照组（平均跟腱断裂评分分别为 78.6 和 99.8）。
非手术治疗的跟腱断裂患者表现出肌腱解剖和功能延长的迹象。通过三维步态分析，在跟腱断裂后 2 至 5 年内，患者在行走时仍存在肌肉力量和功能减弱的情况。未来更广泛地涉及手术和非手术治疗的患者的研究可能会提供更多有价值的信息。
