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Healing of human Achilles tendon ruptures: Radiodensity reflects mechanical properties
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2015 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, no 3, 884-889 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

This study tests the idea of using radiodensity from computed tomography to quantitatively evaluate the healing of ruptured Achilles tendons.

Methods

The radiodensity of the healing tendons in sixty-five patients who were treated for Achilles tendon rupture was measured. The hypothesis was that density would correlate with an estimate for e-modulus, derived from strain, measured by radiostereometry with different mechanical loadings.

Results

Radiodensity 7 weeks after injury was decreased to 67 % (SD 11) of the contralateral, uninjured tendon. There was no improvement in radiodensity from 7 to 19 weeks, whereas at 1 year, it had increased to 106 % (SD 7). Only 2 of 52 measured values at 1 year were lower than the highest value at 19 weeks, i.e. there was minimal overlap. The variation in radiodensity could explain 80 % of the variation in e-modulus, but radiodensity correlated only weakly with e-modulus at each time point separately. At 1 year, both radiodensity and e-modulus correlated with functional results, although weakly.

Conclusions

From 19 weeks onwards, radiodensity appears to reflect mechanical properties of the tendon and might to some extent predict the final outcome. Radiodensity at 7 weeks is difficult to interpret, probably because it reflects both callus and damaged tissues.

Level of evidence

Prospective, diagnostic study, Level II.

Place, publisher, year, edition, pages
2015. Vol. 23, no 3, 884-889 p.
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:liu:diva-91725DOI: 10.1007/s00167-013-2720-8ISI: 000350209300030PubMedID: 24162760OAI: oai:DiVA.org:liu-91725DiVA: diva2:618899
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Stiffness of the healing human Achilles tendon
Open this publication in new window or tab >>Stiffness of the healing human Achilles tendon
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Achilles tendon ruptures in humans are followed by a long period of immobilisation, rehabilitation and limitations of physical activity and sometimes work also. This prolonged period probably leaves a marginal for improvement in the management of this injury. Animal studies have shown that there are several possibilities to influence and improve tendon healing.

The aim of this thesis was to find a way to examine the mechanical properties of the healing human Achilles tendon and, by using that method, to gain a better understanding of the tissue properties and healing process in these tendons. It was also our aim to use our knowledge from animal studies in an attempt to improve tendon healing in humans.

We developed a radiological method using radiostereophotogrammetric analysis (RSA) and computed tomography (CT), which enabled us to measure the stiffness of the healing Achilles tendon. The results of these measurements, as early as 7 weeks after injury correlated with the late clinical results in all studies. Clinical results were measured using a heel-raise test comparing the injured with the non-injured tendon. We could not find a significant difference in stiffness between patients treated surgically or non-surgically. Neither could we demonstrate that platelet-rich plasma improved the mechanical properties of the healing tendon or the clinical outcome, within the limits of the statistical power. In contrast, patients following a specific training programme with early tension loading of the tendon twice a day developed stiffer tendon tissue later in the healing process.

Since RSA is unsuitable for routine clinical use, we evaluated the possibility to use radiodensity findings from CT as a proxy for healing and its correlation to mechanical and clinical results. Density and mechanical properties correlated strongly when analysing all time points together, but only weakly at each particular point in time. Density may still be useful in describing mechanical properties at a later stage of repair, but this remains to be seen.

In conclusion, these studies show that early mechanical properties correlate to late clinical outcome and that the early use of daily tension loading sessions leads to an improvement in the mechanical properties of the tendon tissue.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 59 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1356
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91727 (URN)978-91-7519-674-9 (ISBN)
Public defence
2013-06-04, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2013-05-13Bibliographically approved

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