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The twisted structure of the Achilles tendon unraveled: A detailed quantitative and qualitative anatomical investigation
Author(s) -
Pękala P. A.,
Henry B. M.,
Ochała A.,
Kopacz P.,
Tatoń G.,
Młyniec A.,
Walocha J. A.,
Tomaszewski K. A.
Publication year - 2017
Publication title -
scandinavian journal of medicine and science in sports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.575
H-Index - 115
eISSN - 1600-0838
pISSN - 0905-7188
DOI - 10.1111/sms.12835
Subject(s) - achilles tendon , anatomy , cadaver , tendon , soleus muscle , triceps surae muscle , torsion (gastropod) , medicine , materials science , skeletal muscle
The Achilles tendon ( AT ) consists of fibers originating from the soleus muscle ( SOL ), which lies deep, and the medial ( GM ) and lateral ( GL ) heads of the gastrocnemius muscle, which lie superficial. As the fibers descend toward the insertion of the AT , the individual subtendons twist around each other. The aim of this study was to investigate the twisted structure of the AT and its individual subtendons. Specimens of the AT , with preserved calcaneal bone and a fragment of the triceps surae muscle, were obtained from 53 fresh‐frozen, male cadavers (n=106 lower limbs). The angle of torsion of each of the AT 's subtendons was measured using a specially designed and 3D‐printed tool. The mean distance between the most distal fibers of the triceps surae muscle and the superior border of the calcaneal bone was 60.77±14.15 mm. The largest component of the AT at the level of its insertion into the calcaneal bone is the subtendon from the GL (44.43%), followed by the subtendon from SOL (27.89%), and the subtendon from GM (27.68%). The fibers originating from the GM rotate on average 28.17±15.15°, while the fibers originating from the GL and SOL twist 135.98±33.58° and 128.58±29.63°, respectively. The torsion of superficial fibers ( GM ) comprising the AT is significantly lower than that of deeper fibers ( GL and SOL ). The cross‐sectional area of the AT is smaller at the level of the musculo‐tendinous junction than at the level of its insertion. This study illustrates the three types of the AT with differently twisting subtendons, as well as a generalized model of the AT . Types of AT torsion may potentially alter the biomechanical properties of the tendon, thus possibly influencing the pathophysiologic mechanisms leading to the development of various tendinopathies.