Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture

Md Abdul Alim, Simon Svedman, Gunnar Edman, Paul W Ackermann, Md Abdul Alim, Simon Svedman, Gunnar Edman, Paul W Ackermann

Abstract

Objective: Patients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.

Study design and setting: Prospective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.

Patients: A total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.

Assessments: Markers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).

Results: Patients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=-0.47, p=0.002) and PIIINP (R=-0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.

Conclusions: Assessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.

Trial registration numbers: NCT01317160: Results. NCT02318472: Pre-results.

Keywords: Achilles; Chronic; Collagen; Injuries; Tendon.

Figures

Figure 1
Figure 1
Each circle represents the outcome of one patient, but sometimes the circles are very close or even merge. Univariate analysis followed by regression analyses showed that a higher concentration of procollagen type I N-terminal propeptide (PINP) in the injured Achilles tendon (AT) was related to greater fatigue in the same affected AT (R=0.47, p=0.003). The Achilles tendon Total Rupture Score (ATRS) fatigue data scale was set as (0–10), where 10=no fatigue and 0=worst level of limitation. The figure also illustrates that many patients are affected by fatigue in their injured limb at 1-year follow-up.
Figure 2
Figure 2
Each circle represents the outcome of one patient, but sometimes the circles are very close or even merge. Univariate analysis followed by regression analyses showed that elevated levels of normalised procollagen type I N-terminal propeptide (PINP) in the injured Achilles tendon were significantly and positively correlated with less pain (R=0.38, p=0.019). The Achilles tendon Total Rupture Score (ATRS) pain data scale was set as (0–10), where 10=no pain and 0=worst imaginable pain. The figure furthermore shows that many patients may exhibit some degree of pain in their injured leg at 1-year follow-up.

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