Surgical treatment of chronic Achilles tendon rupture results in improved gait biomechanics

• Published in: Journal of orthopaedic surgery and research Vol. 17; no. 1; p. 67
• Main Authors: Nordenholm, Anna, Senorski, Eric Hamrin, Westin, Olof, Nilsson Helander, Katarina, Möller, Michael, Karlsson, Jón, Zügner, Roland
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.02.2022; BioMed Central; BMC
• Subjects: Achilles tendon; Achilles Tendon - surgery; Adult; Aged; Aged, 80 and over; Analysis; Ankle; Ankle Injuries; Balance; Biomechanical Phenomena; Biomechanics; Delayed treatment; Female; Gait; Gait - physiology; Gait analysis; Humans; Kinematics; Knee; Laboratories; Late detected; Male; Middle Aged; Missed diagnosis; Orthopedics; Ortopedi; Patient assessment; Patients; Rehabilitation; Rupture; Rupture - surgery; Statistical analysis; Surgeons; Tendon Injuries - surgery; Tendons; Three-dimensional; Treatment Outcome; Missed diagnosis; Three-dimensional; Late detected; Delayed treatment; Gait analysis
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-022-02948-2

Chronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not been quantified in the literature. A total of 23 patients with a Chronic Achilles tendon rupture (mean age 61 ± 15 years) underwent three-dimensional gait analysis according to a standardized protocol using an optical tracking system. Data of spatiotemporal, kinematic and kinetic variables were collected preoperatively and one year postoperatively. In addition, the postoperative gait biomechanics were compared with the gait biomechanics of a control group consisting of 70 healthy individuals (mean age 49 ± 20 years). The prospectively collected data were analyzed by an independent t test. Postoperatively, increments were found in gait speed (mean difference - 0.12 m/s), stride length (- 0.12 m), peak ankle moment (- 0.64 Nm/kg), peak ankle power (- 1.38 W/kg), peak knee power (- 0.36 m) and reduced step width (0.01 m), compared with preoperative gait biomechanics (p < 0.014). Compared with the control group, patients with a Chronic Achilles tendon rupture exhibited slower postoperative gait speed (mean difference 0.24 m/s), wider step width (- 0.02 m), shorter stride length (0.16 m), longer relative stance phase (- 2.15%), lower peak knee flexion (17.03 degrees), greater peak knee extension (2.58 degrees), lower peak ankle moment (0.35 Nm/kg), peak ankle power (1.22 W/kg) and peak knee power (1.62 W/kg), (p < 0.010). Surgical intervention and postoperative rehabilitation can be an effective treatment for alterations in gait after a Chronic rupture of the Achilles tendon. However, at one year postoperatively, patients still exhibit impairments in spatiotemporal variables and knee and ankle power compared with healthy controls.