Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures

Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1369-77. doi: 10.1007/s00167-013-2407-1. Epub 2013 Jan 31.


Purpose: The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed.

Methods: In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment. Demographic parameters, time off work, maximum calf circumference and clinical scores (ATRS, Hannover, AOFAS) were evaluated. Muscle volume and cross-sectional area of the calf and AT length were measured on MR images and were compared between groups and to each patient's healthy contralateral leg.

Results: Reduced muscle volume was found across all groups with a higher muscle volume in the conservative (729.9 ± 130.3 cm(3)) compared to the percutaneous group (675.9 ± 207.4 cm(3), p = 0.04). AT length was longer in the affected leg (198.4 ± 24.1 vs. 180.6 ± 25.0 mm, p < 0.0001) without difference in subgroup analysis. Clinically measured ankle dorsiflexion showed poor correlation with AT length (R (2) = 0.07, p = 0.008). Muscle volume strongly correlated with the cross-sectional area (R (2) = 0.6, p < 0.0001) but showed a weak correlation with the Hannover score (R (2) = 0.08, p = 0.048). Maximum calf circumference correlated with muscle volume (R (2) = 0.42, p < 0.0001).

Conclusions: No significant difference between the treatment groups was found in muscle volume, AT length, clinical measures or days off work. Cross-sectional area and maximum calf circumference are cost-effective measurements and a good approximation of muscle volume and can thus be used in a clinical setting while clinical dorsiflexion should not be used.

Publication types

  • Multicenter Study

MeSH terms

  • Achilles Tendon / injuries*
  • Achilles Tendon / pathology
  • Achilles Tendon / surgery
  • Adult
  • Anatomy, Cross-Sectional
  • Cohort Studies
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Muscle, Skeletal / pathology*
  • Organ Size
  • Retrospective Studies
  • Rupture
  • Tendon Injuries / physiopathology*
  • Tendon Injuries / surgery
  • Tendon Injuries / therapy
  • Treatment Outcome
  • Young Adult