Hoeffner Rikke, Svensson Rene B, Magnusson S Peter
Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
Department of Clinical Medicine, Center for Healthy Aging, University of Copenhagen, Denmark.
Transl Sports Med. 2024 Dec 30;2024:9782280. doi: 10.1155/tsm2/9782280. eCollection 2024.
Persisting deficits are often seen years after an Achilles tendon rupture despite dedicated rehabilitation efforts. A possible reason for reduced function is elongation of the tendon and accompanying shortening of the muscle. Strength training with focus on the eccentric component of loading leads to longer muscle fascicles in healthy persons. To investigate if focused eccentric training would result in increased muscle fascicle length, strength and excursion, reduced fat fraction, and functional improvements. Longitudinal within-subject exploratory study. Fourteen persons, with a prior unilateral Achilles tendon rupture who still experienced functional deficits > 1 year after injury, underwent an isokinetic eccentric training program for 12 weeks. Tendon length, muscle fascicle length, cross-sectional area, strength, and functional parameters were measured on the injured and uninjured sides before and after 12 weeks of training. For gastrocnemius fascicle length and fat content in the triceps surae, no significant change over time on the injured or uninjured side was detected. There was a significant interaction effect (=0.0065) and side effect ( < 0.0001) for heel-rise count, resulting in a significantly smaller difference between the sides at 12 weeks compared to baseline. With extended knee, the eccentric and concentric plantar flexion peak torques showed a significant interaction effect (eccentric: =0.0074 and concentric: =0.0187), as well as a significant side effect (eccentric: =0.0002 and concentric: < 0.0001) and time effect (eccentric =0.0179 and concentric =0.0093). Between weeks 0 and 12, ATRS significantly improved (mean difference 11.6 points, 95% CI [4-19], < 0.0001). Fascicle length was not altered by the intervention. However, plantar flexion toque, heel-rise count, and, importantly, the patient-reported outcome measure ATRS improved.
尽管进行了专门的康复训练,但跟腱断裂多年后仍常出现持续的功能缺陷。功能下降的一个可能原因是肌腱延长及伴随的肌肉缩短。针对健康人的力量训练若侧重于负荷的离心部分,会使肌肉束更长。为研究专注的离心训练是否会导致肌肉束长度增加、力量增强、活动范围扩大、脂肪含量降低以及功能改善。纵向受试者内探索性研究。14名既往有单侧跟腱断裂且受伤1年多后仍存在功能缺陷的患者,接受了为期12周的等速离心训练计划。在训练12周前后,对受伤侧和未受伤侧的肌腱长度、肌肉束长度、横截面积、力量及功能参数进行了测量。对于腓肠肌束长度和小腿三头肌脂肪含量,未检测到受伤侧或未受伤侧随时间有显著变化。足跟抬起次数存在显著的交互效应(=0.0065)和侧别效应(<0.0001),与基线相比,12周时两侧差异显著减小。膝关节伸直时,离心和向心跖屈峰值扭矩显示出显著的交互效应(离心:=0.0074,向心:=0.0187),以及显著的侧别效应(离心:=0.0002,向心:<0.0001)和时间效应(离心=0.0179,向心=0.0093)。在第0周和第12周之间,跟腱功能评分(ATRS)显著改善(平均差异11.6分,95%可信区间[4 - 19],<0.0001)。干预未改变肌肉束长度。然而,跖屈扭矩、足跟抬起次数,重要的是,患者报告的结局指标ATRS有所改善。