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Recovery from Achilles Tendon Repair: A Combination of Postsurgery Outcomes and Insufficient Remodeling of Muscle and Tendon.

INTRODUCTION
Achilles tendon rupture (ATR) patients have persistent functional deficits in the triceps surae muscle-tendon unit (MTU). The complex remodeling of the MTU accompanying these deficits remains poorly understood. The purpose of the present study was to associate in vivo and in silico data to investigate the relations between changes in MTU properties and strength deficits in ATR patients.


METHODS
Eleven male subjects who had undergone surgical repair of complete unilateral ATR were examined 4.6 ± 2.0 (mean ± SD) years after rupture. Gastrocnemius medialis (GM) tendon stiffness, morphology and muscle architecture were determined using ultrasonography. The force-length relation of the plantar flexor muscles was assessed at five ankle joint angles. Additionally, simulations (OpenSim) of the GM MTU force-length properties were performed with various iterations of MTU properties found between the unaffected and the affected side.


RESULTS
The affected side of the patients displayed a longer, larger and stiffer GM tendon (13 ± 10%, 105 ± 28% and 54 ± 24%, respectively) compared to the unaffected side. The GM muscle fascicles of the affected side were shorter (32 ± 12%) and with greater pennation angles (21 ± 13%). A mean deficit in plantarflexion moment of 35 ± 15% was measured. Simulations indicate that pairing an intact muscle with a longer tendon shifts the optimal angular range of peak force outside physiological angular ranges, while the shorter muscle fascicles and tendon stiffening seen in the affected side decrease this shift, albeit incompletely.


CONCLUSIONS
These results suggest that the substantial changes in MTU properties found in ATR patients may partly result from compensatory remodeling, although this process appears insufficient to fully restore muscle function.


KEY TERMS
Tendon rupture; stiffness; simulation; muscle force; muscle fascicle; tendon healing.