Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
Scand J Med Sci Sports. 2018 Jan;28(1):294-302. doi: 10.1111/sms.12892. Epub 2017 May 2.
Patients with acute Achilles tendon rupture (ATR) display an extended healing process with varying clinical outcome. Poor microcirculatory blood flow has been suggested to be a significant factor for the healing process. However, whether microcirculation may predict healing outcome has been mostly unknown. Therefore, we investigated whether blood flow in the Achilles tendon may be associated with patient-reported and functional outcomes after ATR. In vivo laser-Doppler flowmetry was used to assess microvascular blood flow bilateral in the Achilles tendons, during post-occlusive reactive hyperemia, of nine patients with acute total ATR at 2 weeks post-operatively. At 3 months post-operatively, patient-reported outcome was assessed using Achilles tendon Total Rupture Score (ATRS). At 1 year a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining validated, independent, patient-reported (ATRS), and functional outcome (heel-rise test) measures. An improved combined patient-reported and functional outcome, ACOS, at 1 year was significantly correlated with higher maximum blood flow (r=.777, P=.040) in the injured limb. Furthermore, enhanced patient-reported outcome, ATRS, at 3 months, was associated with an elevated ratio of maximum to resting blood flow (r=.809, P=.015) in the uninjured limb. Blood flow in early tendon healing is associated with long-term patient-reported and functional outcomes after ATR. The microcirculatory blood flow of both the healing and contralateral Achilles tendon seems to determine the healing potential after injury.
急性跟腱断裂（ATR）患者的愈合过程延长，临床结果各异。血流不畅被认为是愈合过程中的一个重要因素。然而，微循环是否可以预测愈合结果尚不清楚。因此，我们研究了跟腱血流是否与 ATR 后患者报告的和功能结果相关。术后 2 周，采用激光多普勒流量仪评估 9 例急性完全 ATR 患者双侧跟腱在闭塞后反应性充血期间的微血管血流。术后 3 个月，采用跟腱总断裂评分（ATRS）评估患者报告的结果。术后 1 年，通过结合验证的、独立的患者报告（ATRS）和功能结果（足跟抬高试验）措施，获得统一的结果评分跟腱综合结果评分（ACOS）。1 年后，改善的综合患者报告和功能结果 ACOS 与受伤侧的最大血流量显著相关（r=.777，P=.040）。此外，术后 3 个月时，患者报告的结果 ATRS 与未受伤侧的最大血流与静息血流比值升高相关（r=.809，P=.015）。跟腱愈合早期的血流与 ATR 后长期的患者报告和功能结果相关。愈合和对侧跟腱的微循环血流似乎决定了受伤后的愈合潜力。
