title: Acute achilles tendon repair: strength outcomes after an acute bout of exercise in recreational athletes.
abstract: BACKGROUND
  This is the first study to evaluate the effect of an acute bout of exercise on strength evaluation after Achilles tendon (AT) rupture and repair.
  
  
  METHODS
  Forty patients sustained an acute AT injury and met inclusion criteria for this study. At a minimum of 12 months after operative repair, patients were measured for (1) calf circumference, (2) bilateral isokinetic strength on a Cybex dynamometer before and after 30 minutes of walking at 70% maximal exertion, and (3) subjective evaluation by AAOS lower limb core and foot and ankle modules. Follow-up occurred at a mean of 32.4 ± 20.7 (range, 12-80) months after surgery, and patients were on average 44.4 ± 8.6 (range, 20-62) years old. One-tailed Student's paired t tests analyzed significance for strength and fatigue between the involved and uninvolved ankle (P < .05).
  
  
  RESULTS
  The calf circumference of the involved ankle was significantly smaller than the uninvolved ankle by 1.9 cm, or 4.7%. Plantarflexion deficits of the involved ankle ranged from 12% to 18% for peak torque (P < .0001) and from 17% to 25% for work per repetition (P < .0001), but both ankles fatigued at equal proportions as measured after exercise. Dorsiflexion strength of the involved ankle increased 6% to 11% for peak torque (P = .070) and 1% to 25% for peak work (P = .386). Reported AAOS lower limb core and foot and ankle scores averaged 99.8 and 96.0, respectively.
  
  
  CONCLUSIONS
  After an AT rupture with repair, patients had less plantarflexion strength, and equal dorsiflexion strength in the operative leg compared to the uninvolved, normal leg. However, subjective results indicated near normal pain and function despite mild plantarflexion strength deficits. Dorsiflexion strength was normal after repair and remained normal even after an acute bout of exercise. Plantarflexion strength ratios postexercise remained similar to pre-exercise after acute exercise bouts. Athletes reported a "flat tire" feeling while running, which suggests a probable gait adjustment as cause for long-term plantarflexion strength deficits.
  
  
  METHODS
  Level III, cohort study.
authors: Methodist Sports Medicine Center, Thomas A. Brady Clinic, Indianapolis, IN, USA.
authors: David A
authors: DA
authors: Porter
authors: Adam F
authors: AF
authors: Barnes
authors: Angela M
authors: AM
authors: Rund
authors: Ari J
authors: AJ
authors: Kaz
authors: James A
authors: JA
authors: Tyndall
authors: Andrew A
authors: AA
authors: Millis
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D056352:Athletes; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute Achilles tendon repair; dorsiflexion; fatigue; plantarflexion; strength outcomes