Deducted from the literature, it was hypothesized that muscular activation of plantar flexors would be higher in the injured leg compared to the healthy leg across all tasks, while neuromuscular activation pattern would be adapted to decrease excessive load on the ruptured tendon. Thus, the aim of this investigation was to provide evidence for mid-term neuromechanical alterations following open Achilles tendon repair using a combination of performance tests in a large and representative cohort. While the structural changes observed in the tendon’s properties have been well investigated, current literature underscores the importance of taking additional neuromuscular alterations into account when investigating persisting performance deficits after Achilles tendon rupture. Thus, it may be assumed that these alterations of neuromuscular activation contribute to the persisting mid- and long-term functional performance deficits. An altered neuromuscular activation pattern reflected by the augmented tibialis anterior muscle and soleus muscle co-contraction index has been shown to be present. Additionally, studies reported less plantarflexion and increased dorsiflexion during gait which was linked to tendon stiffness and elongation. Further analysis has shown that the repaired Achilles tendon is compliant, but that greater strain results in less effective energy storage, e.g., during hopping tasks. Primarily an increased muscle activity and activation ratio on the injured side has been described during various tasks. The reasons behind these performance deficits may primarily be found in the tendon healing itself however, the neuromuscular impact on these deficits has rarely been investigated. Furthermore, of those that return, many show a reduced performance level in the first year after returning to sport or even longer. Achilles tendon rupture is a severe injury to any athlete and, regardless of the treatment, only about 70% achieve a return to preinjury athletic level.
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