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Oulun yliopiston väitöskirjat

RECOVERY OF CALF MUSCLE ISOKINETIC STRENGTH AFTER ACUTE ACHILLES TENDON RUPTURE, ACTA UNIVERSITATIS OULUENSIS D Medica 1424

ISBN-13:	978-952-62-1618-8
Kieli:	englanti
Kustantaja:	Oulun yliopisto
Oppiaine:	Lääketiede
Painos:	Osajulkaisuväitöskirjan yhteenveto-osa
Painosvuosi:	2017
Sijainti:	Print Tietotalo
Sivumäärä:	108
Tekijät:	HEIKKINEN JUUSO

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Achilles tendon rupture (ATR) conservative treatment result usually good clinical outcome, but despite the treatment method calf muscle strength deficit persist. Recent evidence suggests that surgery might surpass conservative treatment in restoring strength after ATR, but structural explanations for surgery-related improved strength remain uncertain. The purposes of this thesis were to compare calf muscle isokinetic strength recovery, calf muscle volume, fatty degeneration and AT elongation after conservative treatment or after open surgical repair of ATR. An additional aim was to assess the role of fascial augmentation in terms of calf muscle isokinetic strength recovery, AT elongation, calf muscle volume atrophy and fatty degeneration, and their relationship with calf muscle isokinetic strength in long-term follow-up after ATR surgery. Surgery resulted in 10% to 18% greater plantar flexion strength (P = 0.037) compared to conservative treatment. The mean differences between affected and healthy soleus muscle volumes were -18% after surgery and -25% after conservative treatment (P = 0.042). At 18 months, AT were, on average 19 mm longer in patients treated conservatively compared to surgery (P < 0.001). At 18 months, patients with greater (2–3) fatty degeneration had lower soleus muscle volumes and plantar flexion strength in the healthy leg. In long term, augmentation did not affect any of the strength variables, but the injured side showed 12% to 18% strength deficit compared with the healthy side (P < 0.001). The AT was, on average, 12 mm longer in the affected leg than in the healthy leg (P < 0.001). The mean soleus muscle volume was 13% lower in the affected leg than in the healthy leg (P < 0.001). The mean volumes of the medial- and lateral gastrocnemius muscles were 12% and 11% lower in the affected leg than in the healthy leg, respectively (P < 0.001). AT elongation correlated substantially with plantar strength deficit (ρ = 0.51, P < 0.001) and with both gastrocnemius (ρ = 0.46, P = 0.001) and soleus muscle atrophy (ρ = 0.42, P = 0.002). Calf muscle fatty degeneration was more common in the affected leg compared healthy leg (P ≤ 0.018). In conclusion, surgery of ATR restored calf muscle isokinetic strength earlier and more completely than conservative treatment. Conservative treatment resulted in greater soleus muscle atrophy and AT elongation compared surgery, which may partly explain the surgery related better strength results. Augmentation provided no long-term benefits compared with simple suturation, and a 12 to 18% plantar flexion strength deficit compared to the healthy side persisted. AT elongation may explain the smaller calf muscle volumes, greater fatty degeneration, and plantar flexion strength deficit observed in long-term follow-up after surgical repair of ATR.

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