BACKGROUND: Over the past thirty years, there has been dramatic increase in incidence of Achilles tendon rupture in the athletic population. The purpose of this study was to compare the lower extremity mechanics of Achilles tendon ruptured runners with healthy controls. METHODS: The participants with a past history of an Achilles tendon repair (n = 11) and healthy control (n = 11) subgroups were matched on sex, age, type of regular physical activity, mass, height, footfall pattern and lateral dominancy. Running kinetics and kinematics of the ankle, knee and hip were recorded using a high-speed motion capture system interfaced with a force platform. Achilles tendon length was measured using ultrasonography. Main outcome measures were lower extremity joint angles and moments during stance phase of running and Achilles tendon lengths. RESULTS: Athletes from Achilles tendon group had an affected gastro-soleus complex. Athletes with history of Achilles tendon rupture had reduced ankle range of motion during second half of the stance phase of running (Δ7.6°), an overextended knee during initial contact (Δ5.2°) and increased affected knee range of motion (Δ4.4°) during the first half of stance phase on their affected limb compared to the healthy control group. There was a 22% increase in the maximal hip joint moment on contralateral side of the Achilles tendon group compared to the healthy controls. CONCLUSION: These results suggest a compensation mechanism, relatively extended knee at initial ground contact against the deficit in the muscle-tendon complex of the triceps surae. Overextension during sporting activities may place the knee at risk for further injury. Avoidance of AT lengthening and plantarflexion strength deficit after surgery and during rehabilitation might help to manage AT rupture since these factors may be responsible for altered running kinematics.

Department of Human Movement Studies Human Motion Diagnostic Center University of Ostrava Varenska 40 A 70200 Ostrava Czech Republic

Department of Kinesiology and Nutrition Sciences University of Nevada Las Vegas Las Vegas USA

Department of Kinesiology University of Massachusetts Amherst USA

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Malvankar S, Khan WS. Evolution of the Achilles tendon: the athlete’s Achilles heel? Foot. 2011;21:193–197. doi: 10.1016/j.foot.2011.08.004. PubMed DOI

Lantto I, Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J. Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports. 2014;25:133–138. doi: 10.1111/sms.12253. PubMed DOI

Houshian S, Tscherning T, Riegels-Nielsen P. The epidemiology of achilles tendon rupture in a Danish county. Injury. 1998;29:651–654. doi: 10.1016/S0020-1383(98)00147-8. PubMed DOI

Amin NH, Old AB, Tabb LP, Garg R, Toossi N, Cerynik DL. Performance outcomes after repair of complete achilles tendon ruptures in national basketball association players. Am J Sports Med. 2013;41:1864–1868. doi: 10.1177/0363546513490659. PubMed DOI

Parekh S, Wray IIIW, Brimmo O, Sennett B, Wapner K. Epidemiology and outcomes of Achilles tendon ruptures in the National Football League. Foot Ankle Spec. 2009;2:283–286. doi: 10.1177/1938640009351138. PubMed DOI

Bressel E, Larsen BT, McNair PJ, Cronin J. Ankle joint proprioception and passive mechanical properties of the calf muscles after an Achilles tendon rupture: a comparison with matched controls. Clin Biomech. 2004;19:284–291. doi: 10.1016/j.clinbiomech.2003.12.008. PubMed DOI

Rosso C, Vavken P, Polzer C, Buckland DM, Studler U, Weisskopf L, et al. Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc. 2013;21:1369–1377. doi: 10.1007/s00167-013-2407-1. PubMed DOI

Agres AN, Duda GN, Gehlen TJ, Arampatzis A, Taylor WR, Manegold S. Increased unilateral tendon stiffness and its effect on gait 2-6 years after Achilles tendon rupture. Scand J Med Sci Sports. 2015;25:860–867. doi: 10.1111/sms.12456. PubMed DOI

Mullaney MJ, McHugh MP, Tyler TF, Nicholas SJ, Lee SJ. Weakness in end-range plantar flexion after Achilles tendon repair. Am J Sports Med. 2006;34:1120–1125. doi: 10.1177/0363546505284186. PubMed DOI

Suydam SM, Buchanan TS, Manal K, Silbernagel KG. Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2013;23:868–874. doi: 10.1007/s00167-013-2512-1. PubMed DOI PMC

Tengman T, Coleman S, Silbernagel KG, Karlsson J, Riad J. Muscle fatigue after Achilles tendon rupture : a limited heel-rise test with electromyography reveals decreased endurance muscle fatigue after Achilles tendon rupture : a limited heel-rise test with electromyography reveals decreased endurance. Eur J Phys. 2015;17:200–207.

Årøen A, Helgø D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture. Scand J Med Sci Sport. 2004;14:30–33. doi: 10.1111/j.1600-0838.2004.00344.x. PubMed DOI

Nilsson-Helander K, Thomeé R, Silbernagel KG, Grävare-Silbernagel K, Thomeé P, Faxén E, et al. The Achilles tendon Total rupture score (ATRS): development and validation. Am J Sports Med. 2007;35:421–426. doi: 10.1177/0363546506294856. PubMed DOI

Jandacka D, Zahradnik D, Foldyna K, Hamill J. Running biomechanics in a long-term monitored recreational athlete with a history of Achilles tendon rupture. BMJ Case Rep [Internet]. 2013;2013 Available from: https://www.ncbi.nlm.nih.gov/pubmed/23362072 PubMed PMC

Silbernagel KG, Willy R, Davis I. Preinjury and postinjury running analysis along with measurements of strength and tendon length in a patient with a surgically repaired Achilles tendon rupture. J Orthop Sports Phys Ther. 2012;42:521–529. doi: 10.2519/jospt.2012.3913. PubMed DOI

Willy RW, Brorsson A, Powell HC, Willson JD, Tranberg R, Grävare Silbernagel K. Elevated knee joint kinetics and reduced ankle kinetics are present during jogging and hopping after Achilles tendon ruptures. Am J Sports Med. 2017;45:1124–1133. doi: 10.1177/0363546516685055. PubMed DOI

Nunley JA. The Achilles tendon: treatment and rehabilitation. New York: Springer; 2010.

Grimby G. Physical activity and muscle training in the elderly. J Intern Med. 1986;220:233–237. PubMed

Seeley MK, Umberger BR, Shapiro R. A test of the functional asymmetry hypothesis in walking. Gait Posture. 2008;28:24–8. PubMed

Hamill J, Selbie W, Kepple T. Three-dimensional kinematics. In: Robertson D, Caldwell G, Hamill J, Kamen G, Whittlesey S, editors. Res. Methods Biomech. 2. Champaign: Human Kinetics; 2013. pp. 35–60.

Mcclay I, Manall K. A comparison of three-dimensional lower extremity kinematics during running between excessive pronators and normals. Clin Biomech. 1998;13:195–203. doi: 10.1016/S0268-0033(97)00029-6. PubMed DOI

McClay I, Manal K. Three-dimensional kinetic analysis of running: significance of secondary planes of motion. Med Sci Sport Exerc. 1999;31:1629–1637. doi: 10.1097/00005768-199911000-00021. PubMed DOI

Moraux A, Canal A, Ollivier G, Ledoux I, Doppler V, Payan C, et al. Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80 years. BMC Musculoskelet Disord. 2013;14:104. doi: 10.1186/1471-2474-14-104. PubMed DOI PMC

Rees JD, Lichtwark GA, Wolman RL, Wilson AM. The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. Rheumatology (Oxford) 2008;47:1493–1497. doi: 10.1093/rheumatology/ken262. PubMed DOI

Hanavan EP. Mathematical model of the human body. AMRL Techn. OH: Wright-Patterson Air Force Base; 1964.

Robertson E, Gordon D, Caldwell GE, Hamill J, Kamen G, Whittlesey SN. Research methods in biomechanics. 2. Human Kinetics: Champaign; 2014.

Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech. 2008;23:1018–1025. doi: 10.1016/j.clinbiomech.2008.04.017. PubMed DOI

Prilutsky BI, Zatsiorsky V. Tendon action of two-joint muscles: transfer of mechanical energy between joints during jumping, landing, and running. J Biomech. 1994;27:25–34. doi: 10.1016/0021-9290(94)90029-9. PubMed DOI

Robinson RO, Herzog W, Nigg BM. Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry. J Manip Physiol Ther. 1987;10:172–176. PubMed

Cohen J. Statistical power analysis for the behavioral sciences. 2. New Jersey: Erlbaum; 1990.

Carmont MR, Grävare Silbernagel K, Brorsson A, Olsson N, Maffulli N, Karlsson J. The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation. Asia-Pacific J Sport Med Arthrosc Rehabil Technol. 2015;2:49–55. doi: 10.1016/j.asmart.2014.12.002. PubMed DOI PMC

Cooper A, Alghamdi GA, Alghamdi MA, Altowaijri A, Richardson S. The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in Hemiparetic stroke patients. Physiother Res Int. 2012;17:150–156. doi: 10.1002/pri.528. PubMed DOI

Shultz SJ, Nguyen AD, Levine BJ. The relationship between lower extremity alignment characteristics and anterior knee joint laxity. Sport Heal A Multidiscip Approach. 2009;1:54–60. doi: 10.1177/1941738108326702. PubMed DOI PMC

Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35:359–367. doi: 10.1177/0363546506293899. PubMed DOI

Podraza JT, White SC. Effect of knee flexion angle on ground reaction forces, knee moments and muscle co-contraction during an impact-like deceleration landing: implications for the non-contact mechanism of ACL injury. Knee Elsevier BV. 2010;17:291–295. doi: 10.1016/j.knee.2010.02.013. PubMed DOI

Umberger BR. Mechanics of the vertical jump and two-joint muscles: implications for training. Strength Cond J. 1998;20:70. doi: 10.1519/1073-6840(1998)020<0070:MOTVJA>2.3.CO;2. DOI

Hespanhol Junior LC, Pena Costa LO, Lopes AD. Previous injuries and some training characteristics predict running-related injuries in recreational runners: a prospective cohort study. J Physiother Elsevier. 2013;59:263–269. doi: 10.1016/S1836-9553(13)70203-0. PubMed DOI

Knee Joint Kinematics and Kinetics During Walking and Running After Surgical Achilles Tendon Repair