Functional anatomy of the Achilles tendon |
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Authors: | Mahmut Nedim Doral Mahbub Alam Murat Bozkurt Egemen Turhan Ozgür Ahmet Atay Gürhan Dönmez Nicola Maffulli |
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Institution: | (1) Faculty of Medicine, Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey;(2) Sports Medicine Department, Hacettepe University, Ankara, Turkey;(3) Department of Orthopaedic Surgery, Newham University Hospital NHS Trust, London, UK;(4) Department of Orthopedics and Traumatology, Ankara Etlik İhtisas Training and Research Hospital, Ankara, Turkey;(5) Faculty of Medicine, Department of Orthopedics and Traumatology, Karaelmas University, Zonguldak, Turkey;(6) Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK; |
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Abstract: | The Achilles tendon is the strongest and thickest tendon in the human body. It is also the commonest tendon to rupture. It
begins near the middle of the calf and is the conjoint tendon of the gastrocnemius and soleus muscles. The relative contribution
of the two muscles to the tendon varies. Spiralisation of the fibres of the tendon produces an area of concentrated stress
and confers a mechanical advantage. The calcaneal insertion is specialised and designed to aid the dissipation of stress from
the tendon to the calcaneum. The insertion is crescent shaped and has significant medial and lateral projections. The blood
supply of the tendon is from the musculotendinous junction, vessels in surrounding connective tissue and the osteotendinous
junction. The vascular territories can be classified simply in three, with the midsection supplied by the peroneal artery,
and the proximal and distal sections supplied by the posterior tibial artery. This leaves a relatively hypovascular area in
the mid-portion of the tendon where most problems occur. The Achilles tendon derives its innervation from the sural nerve
with a smaller supply from the tibial nerve. Tenocytes produce type I collagen and form 90% of the cellular component of the
normal tendon. Evidence suggests ruptured or pathological tendon produce more type III collagen, which may affect the tensile
strength of the tendon. Direct measurements of forces reveal loading in the Achilles tendon as high as 9 KN during running,
which is up to 12.5 times body weight. |
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