Weakness in end-range plantar flexion after Achilles tendon repair
by
Mullaney MJ, McHugh MP, Tyler TF, Nicholas SJ, Lee SJ.
—
last modified
2009-10-09 15:17
Am J Sports Med. 2006 Jul;34(7):1120-5. Epub 2006 Feb 13.
BACKGROUND: Separation of tendon ends after Achilles tendon repair may affect the
tendon repair process and lead to postoperative end-range plantarflexion
weakness. HYPOTHESIS: Patients will have disproportionate end-range
plantarflexion weakness after Achilles tendon repair. STUDY DESIGN: Descriptive
laboratory study. METHODS: Four-strand core suture repairs of Achilles tendon
were performed on 1 female and 19 male patients. Postoperatively, patients were
nonweightbearing with the ankle immobilized for 4 weeks. Plantarflexion torque,
dorsiflexion range of motion, passive joint stiffness, toe walking, and standing
single-legged heel rise (on an incline, decline, and level surface) were assessed
after surgery (mean, 1.8 years postoperative; range, 6 months-9 years). Maximum
isometric plantarflexion torque was measured at 20 degrees and 10 degrees of
dorsiflexion, neutral, and 10 degrees and 20 degrees of plantar flexion.
Percentage strength deficit (relative to noninvolved leg) was computed at each
angle. Passive dorsiflexion range of motion was measured goniometrically. Passive
joint stiffness was computed from increase in passive torque between 10 degrees
and 20 degrees of dorsiflexion, before isometric contractions. RESULTS:
Significant plantarflexion weakness was evident on the involved side at 20
degrees and 10 degrees of plantar flexion (34% and 20% deficits, respectively; P
<.001), with no torque deficits evident at other angles (6% at neutral, 3% at 10
degrees of dorsiflexion, 0% at 20 degrees of dorsiflexion). Dorsiflexion range of
motion was not different between involved and noninvolved sides (P = .7). Passive
joint stiffness was 34% lower on the involved side (P <.01). All patients could
perform an incline heel rise; 14 patients could not perform a decline heel rise
(P <.01). CONCLUSION: Disproportionate weakness in end-range plantar flexion,
decreased passive stiffness in dorsiflexion, and inability to perform a decline
heel rise are evident after Achilles tendon repair. Possible causes include
anatomical lengthening, increased tendon compliance, and insufficient
rehabilitation after Achilles tendon repair. CLINICAL RELEVANCE: Impairments will
have functional implications for activities (eg, descending stairs and landing
from a jump). Weakness in end-range plantar flexion may be an unrecognized
problem after Achilles tendon repair.