Zhu Sophie, Garofalo Josh, Abuhantash Monther, McRae Sheila, MacDonald Peter, Longstaffe Rob, Ogborn Dan
Department of Surgery, Orthopedic Section University of Manitoba.
Max Rady College of Medicine University of Manitoba.
Int J Sports Phys Ther. 2024 Jun 1;19(6):670-680. doi: 10.26603/001c.117549. eCollection 2024.
While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon (AT) ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping.
HYPOTHESIS/PURPOSE: The purpose of this study was to determine if functional performance including strength, jumping, and hopping outcomes differed between OM and NOM of acute ATR. The secondary objective was to assess the degree of association between AT morphology and performance outcomes.
Retrospective cohort with a single prospective evaluation.
All patients were treated at an institutional secondary care center. Eligible participants (n=12 OM; 12 NOM) who were treated with OM or NOM of ATR within three weeks of injury were evaluated a minimum 20 months following ATR. AT length, thickness and gastrocnemius muscle thickness were assessed with B-mode ultrasound. Isokinetic plantar flexor strength, hop tests and countermovement and drop jumps were completed. Two-way ANOVAS were completed on all tests with unilateral values, independent t-tests were used for bilateral outcomes, and linear regressions were completed to assess the relationship between normalized AT length and performance.
Affected limb AT was elongated and thickened (p<0.01), gastrocnemius was atrophied (p< 0.01) and angle-specific plantar flexor torque was reduced at 120°/s when measured at 20° plantar flexion (p = 0.028). Single leg drop vertical jump was higher in OM (p = 0.015) with no difference for hop and jump tests. AT length was related to plantar flexor torque but had no relationship with hopping performance.
Hop test performance was maintained despite plantarflexion weakness, gastrocnemius atrophy, and AT elongation. This may be the result of compensatory movement patterns. AT length holds limited explanatory power in plantar flexor strength, although this relationship should be evaluated further.
Level III.
虽然对于跟腱断裂（ATR）的手术治疗（OM）与非手术治疗（NOM）的相对益处仍存在争议，但很少有研究探讨其对诸如跳跃等高冲击力动作的影响。
假设/目的：本研究的目的是确定急性ATR的OM和NOM之间在包括力量、跳跃和单腿跳测试结果等功能表现上是否存在差异。次要目的是评估跟腱形态与功能表现结果之间的关联程度。
具有单次前瞻性评估的回顾性队列研究。
所有患者均在一家机构二级护理中心接受治疗。在受伤后三周内接受ATR的OM或NOM治疗的符合条件的参与者（n = 12例OM；12例NOM）在ATR后至少20个月进行评估。使用B超评估跟腱长度、厚度和腓肠肌厚度。完成等速跖屈力量测试、单腿跳测试以及反向跳和纵跳测试。对所有单侧测试值进行双向方差分析，对双侧结果使用独立t检验，并完成线性回归以评估标准化跟腱长度与功能表现之间的关系。
患侧跟腱拉长且增厚（p < 0.01），腓肠肌萎缩（p < 0.01），在20°跖屈位测量时，120°/s的特定角度跖屈扭矩降低（p = 0.028）。OM组的单腿纵跳更高（p = 0.015），单腿跳和跳跃测试无差异。跟腱长度与跖屈扭矩相关，但与单腿跳表现无关。
尽管存在跖屈无力、腓肠肌萎缩和跟腱拉长的情况，但单腿跳测试表现仍得以维持。这可能是代偿性运动模式的结果。跟腱长度在跖屈力量方面的解释力有限，尽管这种关系应进一步评估。
III级。
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