title: Substantial creep in healing human Achilles tendons. A pilot study.
abstract: BACKGROUND
  healing after rupture of the Achilles tendon can be described in terms of mechanical properties of the new-formed tissue, constituting the tendon callus. In previous human studies, the elastic modulus and the density remained almost constant during 3 months after mobilization started, and then improved up to one year. So far, time-dependent deformation of the healing human tendon has not been reported.
  
  
  METHODS
  in a series of 16 patients, operated with Achilles tendon suture, we implanted tantalum beads into the tendon and measured the distance between them repeatedly during 3 min of constant loading, using an ordinary image intensifier. The patients unloaded their leg for 30 min before the test. To avoid bias, all images were investigated in a randomized and blinded order.
  
  
  RESULTS
  total strain during 3 min of constant loading at 7 weeks post injury amounted to 5%, and at 19 weeks to 3%. About half of the strain, after the loading was applied, occurred during the second and third min. Considerable strain also occurred just before loading, when the patient was told that a load would be applied, but before this was actually done.
  
  
  CONCLUSIONS
  the measurements were crude, and this study should be seen as a pilot. Still, visco-elastic properties seem to dominate the mechanical behavior the healing Achilles tendon from start of mobilization to 19 weeks, at least when tested after 30 min rest. This deserves further studies with more precise methods.
authors.affiliation: Orthopedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Aspenberg
authors.affiliation: Orthopedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schepull
keywords: Achilles tendon rupture; tendon healing; visco-elasticity