Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal.
Department of Bioengineering and iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2020 Dec;28(12):4011-4030. doi: 10.1007/s00167-020-06010-8. Epub 2020 May 3.
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.
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.
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.
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 IV.
跟腱断裂（AT）是一种常见的损伤。由于跟腱的延长或机械性能降低，力量缺陷可能会长期存在。本研究旨在对急性 AT 断裂治疗后跟腱延长的发生率和后果的文献进行系统评价。假设延长的跟腱与更差的临床结果相关。
检索 MEDLINE、CENTRAL 和 Web of Science 数据库。符合以下条件的临床研究纳入本研究：与跟腱断裂相关，报告跟腱延长和临床或功能结果，随访时间至少 6 个月；仅纳入测试跟腱延长与其他结果之间统计学相关性（SC）的研究，生物力学研究除外，在这些研究中，统计学上显著的跟腱延长被认为是研究组中的普遍发现。对于这些研究，研究组必须与健康对照组进行比较，或者受伤肢体与未受伤肢体进行比较，以评估生物力学参数。
共纳入 28 篇文献。影像学技术测量的跟腱平均延长长度为 0.15 至 3.1cm（n=17）。10 项研究调查了患者报告的结果测量（PROMs）中的 SCs，其中 2 项研究发现跟腱延长与 SCs 相关。5 项研究报告了力量和功率评估及其与跟腱延长的相关性，其中 2 项研究发现力量下降与跟腱延长之间存在 SCs。在报告生物力学测试数据的 10 项研究中，有 9 项研究发现跟腱延长的影响。在这一组中，有 5 项研究中的 4 项研究发现生物力学参数与 SCs 相关。
本研究发现跟腱延长对生物力学参数有一定影响。在一般人群中，本综述未发现跟腱延长对 PROMs 或随访时功能力量有不良影响的证据。
IV 级。
