Lower extremity work along with triceps surae structure and activation is altered with jumping after Achilles tendon repair

Abstract

Achilles tendon rupture leads to long term plantar flexor deficits. The purpose of this study was to describe changes in jumping biomechanics along with triceps surae structure and activation in individuals after Achilles repair. Eleven individuals 1-3 years following Achilles repair and 10 healthy controls were included. Kinetics and kinematics, analyzed using a constituent lower extremity work (CLEW) approach, and muscle activity using surface electromyography (EMG) were collected during a unilateral hopping task. Triceps surae myotendinous structure was assessed using ultrasound imaging. There were no differences in jump height, absolute limb work, or cost of transport between groups. During takeoff, the knee did more (p < 0.001) and ankle did less concentric work (p < 0.001), and lateral gastrocnemius rate of rise was higher (p = 0.02) on the ruptured side. During landing, the knee did more eccentric work (p = 0.033) and lateral gastrocnemius (p = 0.003) and soleus (p = 0.02) activation amplitude prior to landing was higher on the ruptured side. Individuals after Achilles tendon repair shift work toward the knee and alter muscle recruitment. Differences in lateral gastrocnemius activity may indicate that it is well-situated to generate power during takeoff and assist in landing with the soleus. The lack of change in muscle activity and decreased cross sectional area of the medial gastrocnemius may suggest that this muscle atrophies and does not accommodate to the hopping task. Clinical Significance: Proximal lower extremity strengthening along with emphasizing medial gastrocnemius and soleus activation during the recovery of patients with Achilles tendon repair may be rehabilitative targets for improved jumping performance. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Keywords: ankle; electromyography; kinematics; kinetics; myotendinous structure.

Figure 1:

Marker set used for motion analysis.

Figure 2:

Results of CLEW analysis for ruptured, uninjured, and control conditions. Pie charts are scaled to cost of transport (defined as total vertical displacement of center of mass), which is pictured in the white center circle. (A): Ankle, (K): Knee, (H): Hip.

Figure 3:

Ensemble curves for muscle activity in lateral gastrocnemius (A), medial gastrocnemius (B), and soleus (C) during hopping task for ruptured, uninjured, and control conditions. X-axis is percent hop from toe-off to toe-off. The first dashed line indicated the biomechanical event of initial contact, the second indicates peak knee flexion.