Progression of partial to complete ruptures of the Achilles tendon during rehabilitation: A study using a finite element model.

Autor: Diniz P; Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal.; Department of Bioengineering and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.; Associate Laboratory i4HB - Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.; Fisiogaspar, Lisboa, Portugal., Quental C; IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal., Pereira H; Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.; Ripoll y De Prado Sports Clinic: FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.; University of Minho ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal., Lopes R; Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal., Kerkhoffs GMMJ; Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands., Ferreira FC; Department of Bioengineering and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.; Associate Laboratory i4HB - Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal., Folgado J; IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
Jazyk: angličtina
Zdroj: Journal of orthopaedic research : official publication of the Orthopaedic Research Society [J Orthop Res] 2024 Aug; Vol. 42 (8), pp. 1670-1681. Date of Electronic Publication: 2024 Mar 12.
DOI: 10.1002/jor.25827
Abstrakt: Substantial research on complete Achilles tendon ruptures is available, but guidance on partial ruptures is comparatively sparse. Conservative management is considered acceptable in partial tendon ruptures affecting less than 50% of the tendon's width, but supporting experimental evidence is currently lacking. Using a previously validated finite element model of the Achilles tendon, this study aimed to assess whether loading conditions simulating an early functional rehabilitation protocol could elicit progression to a complete rupture in partial ruptures of varying severity. In silico tendon rupture simulations were performed to locate the most likely rupture site for least, moderate, and extreme subtendon twist configurations. These three models were split at the corresponding rupture site and two sets of partial ruptures were created for each, starting from the medial and lateral sides, and ranging from 10% to 50% loss of continuity. Simulations were conducted with material parameters from healthy and tendinopathic tendons. Partial ruptures were considered to progress if the volume of elements showing a maximum principal strain above 10% exceeded 3 mm 3 . To assess whether the tendinopathic tendons typical geometric characteristics could compensate for the inferior material properties found in tendinopathy, an additional model with increased cross-sectional area in the free tendon region was developed. Progression to complete ruptures occurred even with less than a 50% loss of continuity, regardless of subtendon twisting, and material parameters. The tendinopathic tendon model with increased cross-sectional area showed similar results. These findings suggest the current criteria for surgical treatment of partial ruptures should be reconsidered. Statement of clinical significance: The clinical significance and most appropriate treatment of partial ruptures of the Achilles tendon is unclear. Despite the widespread use of the "50% rule" in treatment decisions of partial tendon ruptures, experimental evidence supporting it is missing. The present study provides new data, from a validated aponeurotic and free Achilles tendon finite element model, showing that partial ruptures may progress to complete ruptures under loading conditions elicited from functional rehabilitation protocols, even for partial ruptures affecting less than 50% of the tendon's width. Under these novel findings, the current criteria for surgical treatment of partial ruptures should be reconsidered.
(© 2024 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)
Databáze: MEDLINE
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