Higher pyruvate levels after Achilles tendon rupture surgery could be used as a prognostic biomarker of an improved patient outcome

Knee Surg Sports Traumatol Arthrosc. 2021 Jan;29(1):300-309. doi: 10.1007/s00167-020-06037-x. Epub 2020 May 6.


Purpose: The primary aim of this study was to assess the relationship between the metabolites lactate and pyruvate in the healing tendon after Achilles tendon rupture (ATR) and patient-reported outcome at 6 and 12 months. A secondary aim was to evaluate which underlying factors regulate lactate and pyruvate concentrations.

Methods: Lactate and pyruvate concentrations were measured two weeks post-operatively in both the healing- and healthy Achilles tendon in 109 patients (90 men, 19 women; mean age 40 ± 7.9 years). Patient demographics, degree of physical activity, timing of surgery, operation time, patient-reported loading and step counts were investigated in relation to metabolite concentrations. At 6 and 12 months, the Achilles tendon Total Rupture Score (ATRS) questionnaire was used to assess patient outcome.

Results: The mean number of steps taken during the post-operative days 1-10 was the only factor significantly related to the mean concentration of lactate (R2 = 0.34, p = 0.038), and pyruvate (R2 = 0.46, p = 0.006). Pyruvate was demonstrated as the only factor significantly associated with ATRS at both 6 months (R2 = 0.32, p = 0.003) and at 12 months (R2 = 0.37, p = 0.004) using multiple linear regression.

Conclusion: The mean concentration of pyruvate during early ATR healing may predict patient outcome at 6 and 12 months post-operatively and possibly be used as a biomarker of healing. Early mobilization with an increased number of steps taken is an important clinical strategy to improve the metabolite concentrations during healing.

Level of evidence: III.

Keywords: Achilles tendon; Biomarker; Early mobilization; Healing; Lactate; Patient-reported outcome measures; Pedometer; Pyruvate; Rupture.

MeSH terms

  • Achilles Tendon / injuries*
  • Achilles Tendon / metabolism
  • Achilles Tendon / physiopathology
  • Achilles Tendon / surgery*
  • Adult
  • Biomarkers / metabolism
  • Early Ambulation
  • Exercise
  • Female
  • Humans
  • Lactic Acid / metabolism
  • Male
  • Middle Aged
  • Operative Time
  • Patient Reported Outcome Measures*
  • Pyruvic Acid / metabolism*
  • Rupture / physiopathology
  • Rupture / surgery
  • Time-to-Treatment
  • Treatment Outcome
  • Wound Healing / physiology


  • Biomarkers
  • Lactic Acid
  • Pyruvic Acid