The structural and mechanical properties of the Achilles tendon 2 years after surgical repair

Background Acute ruptures of the Achilles tendon affect the tendon's structural and mechanical properties. The long-term effects of surgical repair on these properties remain unclear. Purpose To evaluate effects of early mobilization versus traditional immobilization rehabilitation programs 2 years after surgical Achilles tendon repair, by comparing force-elongation and stress-strain relationships of the injured tendon to those of the uninjured tendon. Methods A group of males with previous Achilles tendon rupture (n = 18) and a group of healthy male controls (n = 9) participated. Achilles tendon rupture group consisted of patients that had received early mobilization (n = 9) and patients that had received traditional immobilization with a plaster cast (n = 9). Comparisons of tendon structural and mechanical properties were made between Achilles tendon rupture and healthy control groups, and between the uninjured and injured sides of the two rehabilitation groups in Achilles tendon rupture group. Ultrasound was used to determine bilaterally tendon cross-sectional area, tendon resting length, and tendon elongation as a function of torque during maximal voluntary plantar flexion. From these data, Achilles tendon force-elongation and stress-strain relationships were determined. Findings The Achilles tendon rupture group uninjured side was not different from healthy control group. Structural and mechanical parameters of the injured side were not different between the Achilles tendon rupture early mobilization and the immobilization groups. Compared to the uninjured side, the injured side showed a reduction in stress at maximal voluntary force, in Young's modulus and in stiffness. Interpretation Two years post-surgical repair, the Achilles tendon mechanical properties had not returned to the uninjured contralateral tendon values

Preference and torque asymmetry for elbow joint Preferência e assimetria de torque na articulação do cotovelo

Extensively unilateral recruitment for daily activities may determine performance asymmetries in favor of the preferred side eliciting functional adaptation. Our study evaluated asymmetries in elbow torque output between preferred and non-preferred limbs. Eighteen subjects performed maximal elbow flexor and extensor isometric contractions at five different elbow joint angles (0º, 30º, 60º, 90º, 120º) and five different angular velocities (60, 120, 180, 240, 300º.s-1) on an isokinetic dynamometer. Higher flexor torque in favor of preferred arm was observed at 90º of flexion (p<0.05), which also corresponded to the highest torque produced (p<0.05). The fact that joint angle influenced torque asymmetries, whereas angular velocity did not, suggest that the observed asymmetry is likely related to preferential recruitment of elbow flexors at a 90º joint angle for daily tasks requiring high levels of force production. Muscle functional adaptation to frequent stimuli at this joint angle in healthy subjects may explain these results.<br>O frequente recrutamento unilateral de membros superiores pode determinar assimetrias de desempenho em favor do lado preferido, resultando em adaptação funcional. Assimetrias no torque gerado pelos músculos do cotovelo entre o membro preferido e não-preferido foram avaliadas. Dezoito sujeitos realizaram contrações máximas de flexo-extensão do cotovelo em cinco ângulos articulares (0º, 30º, 60º, 90º, 120º) e cinco velocidades angulares (60, 120, 180, 240, 300º.s-1) em um dinamômetro isocinético. Torque flexor mais elevado em favor do lado preferido foi encontrado no ângulo de 90º (p<0,05), que também correspondeu ao ângulo de maior torque (p<0,05). O fato de o ângulo articular determinar assimetrias no torque (enquanto a velocidade angular não) sugere que o recrutamento preferencial dos flexores do cotovelo em um ângulo de 90º nas tarefas da vida diária que requerem força elevada é responsável pela assimetria. Adaptação funcional a estímulos frequentes nesse ângulo articular pode explicar esses resultados em sujeitos saudáveis