The Impact of Achilles Tendon Rupture on the Structure and Function of the Achilles Tendon and Plantarflexors after Non-Surgical Management: A Cross-Sectional Study
S Briggs-Price, T Yates, J Mangwani, M Bhatia, A Jones, KG Silbernagel, K Herbert-Losier, RJ de Vos, NL Millar, B Vicenzino, S O’Neill
Introduction: Acute Achilles Tendon Ruptures (ATR) cause lasting muscular deficits and impair function and quality of life. This study aimed to understand recovery post rupture by examining tendon structure using ultrasound tissue characterisation (UTC), isometric plantarflexor strength, physical activity and patient reported outcomes (PROM).
Methods: Cross-sectional study design consisting of 90 participants. Data were collected from 15 participants at six different rehabilitation timepoints (0, 8, 10 weeks, 4, 6, 12 months). Participants were recruited from a National Health Service clinic using non-surgical management.
Findings: Participants mean (SD) age 48 years (16), 91% male, body mass index 29kg/m2, 54% white British with a median of 1 comorbidity. Primary mechanism of injury was sport (71.1%). Deep vein thrombosis rate was 9.3%. Based on UTC, ruptured tendon cross-sectional area (CSA) was 287.55 mm2 at 10 weeks, 203.62mm2 at 12 months. Disorganised fibrillar structure was 32% lower at 12 months than 10 weeks. Disorganised fibre percentage was consistent at each assessment point (10 weeks:32%, 12 months:30%). Isometric plantarflexor strength on the ruptured limb at 12 months was 61.3kg (20.8) or 0.7x body weight (BW) whilst the non-ruptured limb was 93.3kg (29.5) or 1.1x BW. Daily steps increased from 3720 (1889.8) at week 0 to 9048.4
(2750.1) at 12 months. PROMs at 12 months; ATRS 75.1 (16.5), EQ-5D index .91, EQ-5D VAS 75 (23), SF-36 Physical Functioning 84.3 (9.2), Tampa Scale for Kinesiophobia 34.7 (4.8).
Conclusion: There is substantial remodelling of the tendon during the initial 12 months post ATR, with tendon CSA differing 29% across assessment points. Proportion of disorganised collagen remains consistent from 10 weeks to 12 months post ATR, whilst CSA reduces. Individuals presenting with ATR managed non-surgically have a 34% or 0.4xBW isometric strength deficit at 12 months and still present with fear of movement and reduced function based on PROMs.
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