Rennbahnklinik, Muttenz, Basel, Switzerland.
Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center Freiburg, Albert-Ludwigs University of Freiburg, Freiburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2517-2527. doi: 10.1007/s00167-021-06512-z. Epub 2021 Mar 3.
To assess whether the neuromuscular activation pattern following Achilles tendon rupture and repair may contributes to the observable functional deficits in this severe and increasingly frequent injury.
In this study, the neuromuscular activation using surface EMG of n = 52 patients was assessed during a battery of functional performance tasks to assess potential alterations of muscular activation and recruitment. We analyzed the injured leg vs. the contralateral healthy leg at a mean of 3.5 years following open surgical repair. The testing battery included isokinetic strength testing, bipedal and single-legged heel-rise testing as well as gait analysis.
During isokinetic testing, we observed a higher activation integral for all triceps surae muscles of the injured side during active dorsiflexion, e.g., eccentric loading on the injured leg, while concentric plantarflexion showed no significant difference. Dynamic heel-rise testing showed a higher activation in concentric and eccentric loading for all posterior muscles on the injured side (not significant); while static heel-rise for 10 sec. revealed a significantly higher activation. Further analysis of frequency of fast Fourier-transformed EMG revealed a significantly higher median frequency in the injured leg. Gait analysis revealed a higher pre-activation of the tibialis anterior before ground contact, while medial and lateral gastrocnemius muscles of the injured leg showed a significantly higher activation during push-off phase.
The results of this study provide evidence on the neuromuscular changes 3.5 years following open surgical Achilles tendon repair. These complex neuromuscular changes are manifested to produce the maximum force output whilst protecting the previously injured tendon. The observed alterations may be related to an increased recruitment of type II muscle fibers which could make the muscles prone to fatigue.
III.
评估跟腱断裂和修复后神经肌肉激活模式是否导致这种严重且日益常见的损伤中可观察到的功能缺陷。
在这项研究中，通过表面肌电图评估了 n = 52 例患者的神经肌肉激活情况，以评估肌肉激活和募集的潜在变化。我们在开放性手术修复后平均 3.5 年分析了受伤侧和对侧健康侧的情况。测试电池包括等速力量测试、双足和单足跟腱抬起测试以及步态分析。
在等速测试中，我们观察到受伤侧所有比目鱼肌在主动背屈时（例如，受伤侧的离心加载）的激活积分更高，而向心跖屈时没有显著差异。动态跟腱抬起测试显示，受伤侧所有后侧肌肉在向心和离心加载时的激活更高（不显著）；而 10 秒的静态跟腱抬起测试显示出明显更高的激活。进一步对肌电图快速傅里叶变换的频率分析显示，受伤侧的中值频率明显更高。步态分析显示，在触地前，胫骨前肌的预激活更高，而受伤侧的内侧和外侧腓肠肌在蹬离阶段的激活明显更高。
这项研究的结果提供了开放性手术修复跟腱后 3.5 年的神经肌肉变化证据。这些复杂的神经肌肉变化表现为在保护先前受伤的肌腱的同时产生最大的力输出。观察到的变化可能与 II 型肌纤维的募集增加有关，这可能使肌肉容易疲劳。
III。
