Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture Long-Term Follow-up of Patients in a Previous Study
Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture Long-Term Follow-up of Patients in a Previous Study
复制标题
DOI：
10.2106/jbjs.16.01491
复制
发表时间：
2017-09-20
影响因子：
5.3
通讯作者：
Leppilahti, Juhana
中科院分区：
文献类型：
--
作者：
Heikkinen, Juuso;Lantto, Iikka;Leppilahti, Juhana
背景资料：在这项前瞻性研究中，我们使用磁共振成像（MRI），以评估长期的跟腱长度，小腿肌肉体积和肌肉脂肪变性手术后急性跟腱rupture.Methods：从1998年至2001年，60例患者在我们的中心进行了手术急性跟腱断裂，然后早期功能术后康复。55例患者在最短随访时间13年（平均14年）后重新检查，其中52例纳入本研究。结果测量包括跟腱长度，小腿肌肉体积，以及用MRI测量的患腿和未受伤腿的脂肪变性。结果：患侧小腿的跟腱平均比健侧长12 mm（95%可信区间[CI] = 8.6 ~ 15.6 mm; p < 0.001）（长6%）。比目鱼肌和腓肠肌内侧和外侧的平均体积为63厘米（3）（13%; p < 0.001），30 cm（3）（13%; p < 0.001）和16 cm（3）（11%; p < 0.001），而屈拇长肌（FHL）的平均体积为5 cm 3（5%; p = 0.002），表明FHL代偿性肥大。在整个活动范围内，中位跖屈强度比健侧低12%至18%。最后，跟腱长度的侧到侧差异与力量缺陷基本相关（r = 0.51，p < 0.001），与腓肠肌内侧（r = 0.46，p = 0.001）和比目鱼肌（r = 0.42，p = 0.002）肌萎缩。跟腱长度增加与跟腱断裂手术修复后小腿肌肉体积减小和持续性跖屈强度缺陷相关。FHL肥大可部分补偿力量不足和肌肉体积不足，但比目鱼肌和腓肠肌体积不足11%至13%，跖屈力量不足12%至18%，即使在长期随访后仍持续存在。
Background: In this prospective study, we used magnetic resonance imaging (MRI) to assess long-term Achilles tendon length, calf muscle volume, and muscle fatty degeneration after surgery for acute Achilles tendon rupture.Methods: From 1998 to 2001, 60 patients at our center underwent surgery for acute Achilles tendon rupture followed by early functional postoperative rehabilitation. Fifty-five patients were reexamined after a minimum duration of followup of 13 years (mean, 14 years), and 52 of them were included in the present study. Outcome measures included Achilles tendon length, calf muscle volume, and fatty degeneration measured with MRI of both the affected and the uninjured leg. The isokinetic plantar flexion strength of both calves wasmeasured and was correlated with the structural findings.Results: The Achilles tendon was, on average, 12 mm (95% confidence interval [CI] = 8.6 to 15.6 mm; p < 0.001) longer (6% longer) in the affected leg than in the uninjured leg. The mean volumes of the soleus and medial and lateral gastrocnemius muscles were 63 cm(3) (13%; p < 0.001), 30 cm(3) (13%; p < 0.001), and 16 cm(3) (11%; p < 0.001) lower in the affected leg than in the uninjured leg, whereas the mean volume of the flexor hallucis longus (FHL) was 5 cm3 (5%; p = 0.002) greater in the affected leg, indicating FHL compensatory hypertrophy. The median plantar flexion strength for the whole range of motion ranged from 12% to 18% less than that on the uninjured side. Finally, the side-to-side difference in Achilles tendon length correlated substantially with the strength deficit (r = 0.51, p < 0.001) and with medial gastrocnemius (r = 0.46, p = 0.001) and soleus (r = 0.42, p = 0.002) muscle atrophy.Conclusions: Increased Achilles tendon length is associated with smaller calf muscle volumes and persistent plantar flexion strength deficits after surgical repair of Achilles tendon rupture. Strength deficits and muscle volume deficits are partly compensated for by FHL hypertrophy, but 11% to 13% deficits in soleus and gastrocnemius muscle volumes and 12% to 18% deficits in plantar flexion strength persist even after long-term follow-up.