Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures.
OBJECTIVE
The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed.


METHODS
In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment. Demographic parameters, time off work, maximum calf circumference and clinical scores (ATRS, Hannover, AOFAS) were evaluated. Muscle volume and cross-sectional area of the calf and AT length were measured on MR images and were compared between groups and to each patient's healthy contralateral leg.


RESULTS
Reduced muscle volume was found across all groups with a higher muscle volume in the conservative (729.9 ± 130.3 cm(3)) compared to the percutaneous group (675.9 ± 207.4 cm(3), p = 0.04). AT length was longer in the affected leg (198.4 ± 24.1 vs. 180.6 ± 25.0 mm, p < 0.0001) without difference in subgroup analysis. Clinically measured ankle dorsiflexion showed poor correlation with AT length (R (2) = 0.07, p = 0.008). Muscle volume strongly correlated with the cross-sectional area (R (2) = 0.6, p < 0.0001) but showed a weak correlation with the Hannover score (R (2) = 0.08, p = 0.048). Maximum calf circumference correlated with muscle volume (R (2) = 0.42, p < 0.0001).


CONCLUSIONS
No significant difference between the treatment groups was found in muscle volume, AT length, clinical measures or days off work. Cross-sectional area and maximum calf circumference are cost-effective measurements and a good approximation of muscle volume and can thus be used in a clinical setting while clinical dorsiflexion should not be used.
Orthopaedic Department, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. Claudio.Rosso@unibas.ch
Claudio
C
Rosso
Patrick
P
Vavken
Caroline
C
Polzer
Daniel M
DM
Buckland
Ueli
U
Studler
Lukas
L
Weisskopf
Marc
M
Lottenbach
Andreas Marc
AM
Müller
Victor
V
Valderrabano
D000125:Achilles Tendon / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D000328:Adult; D019412:Anatomy, Cross-Sectional; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009929:Organ Size; D012189:Retrospective Studies; D012421:Rupture; D013708:Tendon Injuries / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult