{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:38:07Z","timestamp":1787315887937,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Achilles tendon rupture (ATR) is a serious lower limb injury that may result in persistent deficits in strength and endurance of the calf muscles. Compensatory mechanisms at proximal joints are known, but the effects of fatigue are less studied. The aim was therefore to evaluate the effect of a fatigue protocol on lower limb kinetics during performance of single\u2010limb drop countermovement jumps (CMJ) in individuals with a history of a unilateral ATR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty participants were recruited on average 2 years after ATR. Drop CMJs were performed on each side before and after a fatigue protocol, and peak power values for the hip, knee and ankle joints were calculated, as well as jump height and duration. A mixed model analysis of variance was used to evaluate inter\u2010limb differences pre\u2010 and post\u2010fatigue during the landing (eccentric) and push\u2010off (concentric) phases of the involved (INV) and uninvolved (UNinv) side.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The fatigue protocol had a greater effect on peak ankle joint power of the UNinv side across both phases (by a mean [95% confidence interval, CI] of 1.06 [0.58\u20131.54] W\/kg) compared to the INV side (0.51 [0.03\u20131.00]\u2009W\/kg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039). Moreover, greater fatigue\u2010induced changes in ankle joint power were found during landing (by a mean [95% CI] of 1.13 [0.64\u20131.61] W\/kg) compared to push\u2010off (0.45 [0.04\u20130.93] W\/kg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), across both sides. A trend towards increased knee joint power was seen as a response to fatigue across both sides and phases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.062), with no change at the hip.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rehabilitation following ATR should emphasize progressive reliance on the INV side across the rehabilitation continuum by incorporating strength, endurance and training under fatigued conditions. This approach may help reduce compensatory reliance on the UNinv side, potentially lowering the risk of overuse\u2011related injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70579","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:18:01Z","timestamp":1787314681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of fatigue are more pronounced on the uninjured side during single\u2010limb jumps 2 years after an acute Achilles tendon rupture"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5245-2426","authenticated-orcid":false,"given":"Unnur S\u00e6d\u00eds","family":"J\u00f3nsd\u00f3ttir","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0777-2399","authenticated-orcid":false,"given":"Roy","family":"Tranberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7566-407X","authenticated-orcid":false,"given":"Karin Gr\u00e4vare","family":"Silbernagel","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy University of Delaware Newark Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9099-9529","authenticated-orcid":false,"given":"Annelie","family":"Brorsson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0606-991X","authenticated-orcid":false,"given":"Krist\u00edn","family":"Briem","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Research Centre of Rehabilitation and Movement Science, School of Health Sciences University of Iceland Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"3856","DOI":"10.1177\/03635465221129284","article-title":"Comparable recovery and compensatory strategies in heel\u2010rise performance after a surgically repaired acute Achilles tendon rupture: an in vivo kinematic analysis comparing early functional mobilization and standard treatment","volume":"50","author":"Aufwerber S","year":"2022","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.jfas.2023.12.008","article-title":"Return to play and functional outcomes following treatment of acute Achilles tendon ruptures: a systematic review and meta\u2010analysis","volume":"63","author":"Bak BM","year":"2024","journal-title":"J Foot Ankle Surg"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"3388","DOI":"10.1177\/0363546517693846","article-title":"Effect of fatigue protocols on lower limb neuromuscular function and implications for anterior cruciate ligament injury prevention training: a systematic review","volume":"45","author":"Barber\u2010Westin SD","year":"2017","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_5_1","doi-asserted-by":"crossref","DOI":"10.1177\/23259671231211282","article-title":"Effect of the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) on calf muscle volume and tendon elongation after acute Achilles tendon rupture: a predefined secondary analysis of the first 60 patients in a randomized controlled trial","volume":"11","author":"Barfod KW","year":"2023","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s40279-019-01052-6","article-title":"Revised approach to the role of fatigue in anterior cruciate ligament injury prevention: a systematic review with meta\u2010analyses","volume":"49","author":"Benjaminse A","year":"2019","journal-title":"Sports Med"},{"issue":"1","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967116679640","article-title":"Effects of sex and fatigue on biomechanical measures during the drop\u2010jump task in children","volume":"5","author":"Briem K","year":"2017","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1177\/0363546517737055","article-title":"Calf muscle performance deficits remain 7 years after an Achilles tendon rupture","volume":"46","author":"Brorsson A","year":"2018","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"3060","DOI":"10.1177\/0363546517717698","article-title":"Heel\u2010rise height deficit 1 year after Achilles tendon rupture relates to changes in ankle biomechanics 6 years after injury","volume":"45","author":"Brorsson A","year":"2017","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1080\/026404102320761787","article-title":"Criterion\u2010related validity of the Borg ratings of perceived exertion scale in healthy individuals: a meta\u2010analysis","volume":"20","author":"Chen MJ","year":"2002","journal-title":"J Sports Sci"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/j.clinbiomech.2006.07.004","article-title":"The effect of lower extremity fatigue on shock attenuation during single\u2010leg landing","volume":"21","author":"Coventry E","year":"2006","journal-title":"Clin Biomech"},{"key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"4011","DOI":"10.1007\/s00167-020-06010-8","article-title":"Achilles tendon elongation after acute rupture: is it a problem? A systematic review","volume":"28","author":"Diniz P","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_13_1","doi-asserted-by":"crossref","first-page":"3730","DOI":"10.1007\/s00167-015-3544-5","article-title":"Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients","volume":"24","author":"Ganestam A","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_14_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.0954-6820.1986.tb08956.x","article-title":"Physical\u2010activity and muscle training in the elderly","volume":"220","author":"Grimby G","year":"1986","journal-title":"Acta Med Scand"},{"key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"401","DOI":"10.2340\/17453674.2024.41089","article-title":"Regional variations in incidence and treatment trends of Achilles tendon ruptures in Finland: a nationwide study","volume":"95","author":"Hallinen M","year":"2024","journal-title":"Acta Orthop"},{"key":"e_1_2_13_16_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jbiomech.2025.113082","article-title":"Differential contributions of lower leg muscle activation to plantar flexor function during single\u2010leg hopping one year after Achilles tendon rupture: a shift from monoarticular to biarticular muscle work","volume":"195","author":"Har\u00f0arson GR","year":"2026","journal-title":"J Biomech"},{"key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1053\/j.jfas.2024.04.005","article-title":"Gender differences in Achilles tendon ruptures\u2014a retrospective study and a review of the literature","volume":"63","author":"Hartman H","year":"2024","journal-title":"J Foot Ankle Surg"},{"key":"e_1_2_13_18_1","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.2106\/JBJS.16.01491","article-title":"Tendon length, calf muscle atrophy, and strength deficit after acute Achilles tendon rupture long\u2010term follow\u2010up of patients in a previous study","volume":"99","author":"Heikkinen J","year":"2017","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1016\/j.injury.2017.04.007","article-title":"Increasing age in Achilles rupture patients over time","volume":"48","author":"Ho G","year":"2017","journal-title":"Injury"},{"key":"e_1_2_13_20_1","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1177\/0363546514540599","article-title":"Acute Achilles tendon ruptures incidence of injury and surgery in Sweden between 2001 and 2012","volume":"42","author":"Huttunen TT","year":"2014","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1002\/tsm2.261","article-title":"The effect of fear of reinjury on joint power distribution during a drop countermovement jump two years after an Achilles tendon rupture","volume":"4","author":"J\u00f3nsd\u00f3ttir US","year":"2021","journal-title":"Translat Sports Med"},{"issue":"2","key":"e_1_2_13_22_1","doi-asserted-by":"crossref","DOI":"10.1177\/23259671221145199","article-title":"Factors that affect return to sports after an Achilles tendon rupture: a qualitative content analysis","volume":"11","author":"J\u00f3nsd\u00f3ttir US","year":"2023","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_23_1","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.2106\/00004623-199907000-00017","article-title":"Current concepts review\u2014rupture of the Achilles tendon","volume":"81","author":"Maffulli N","year":"1999","journal-title":"J Bone Joint Surg"},{"key":"e_1_2_13_24_1","doi-asserted-by":"crossref","first-page":"3781","DOI":"10.1177\/03635465231206391","article-title":"Quantitative assessment of calf muscle volume, strength, and quality after Achilles tendon rupture repair: a 1\u2010year prospective follow\u2010up study","volume":"51","author":"Mashimo S","year":"2023","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_25_1","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1177\/0363546510376052","article-title":"Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures","volume":"38","author":"Nilsson\u2010Helander K","year":"2010","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_26_1","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/0363546506294856","article-title":"The Achilles tendon total rupture score (ATRS): development and validation","volume":"35","author":"Nilsson\u2010Helander K","year":"2007","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_27_1","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s00167-011-1511-3","article-title":"Major functional deficits persist 2 years after acute Achilles tendon rupture","volume":"19","author":"Olsson N","year":"2011","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_28_1","doi-asserted-by":"crossref","first-page":"2867","DOI":"10.1177\/0363546513503282","article-title":"Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study","volume":"41","author":"Olsson N","year":"2013","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_29_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2519\/jospt.2018.7684","article-title":"Individuals post Achilles tendon rupture exhibit asymmetrical knee and ankle kinetics and loading rates during a drop countermovement jump","volume":"48","author":"Powell HC","year":"2018","journal-title":"J Orthop Sports Phys Ther"},{"key":"e_1_2_13_30_1","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1161\/01.CIR.38.6.1104","article-title":"Physiological analysis of middle\u2010aged and old former athletes. Comparison with still active athletes of the same ages","volume":"38","author":"Saltin B","year":"1968","journal-title":"Circulation"},{"key":"e_1_2_13_31_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.2519\/jospt.2010.3295","article-title":"The effect of fatigue on lower\u2010limb biomechanics during single\u2010limb landings: a systematic review","volume":"40","author":"Santamaria LJ","year":"2010","journal-title":"J Orthop Sports Phys Ther"},{"key":"e_1_2_13_32_1","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s00167-009-0889-7","article-title":"A new measurement of heel\u2010rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture","volume":"18","author":"Silbernagel KG","year":"2010","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_33_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.32098\/mltj.01.2016.12","article-title":"Extended field of view ultrasound imaging to evaluate Achilles tendon length and thickness: a reliability and validity study","volume":"6","author":"Silbernagel KG","year":"2016","journal-title":"Muscles Ligaments Tendons J"},{"key":"e_1_2_13_34_1","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1007\/s00167-021-06512-z","article-title":"Neuromechanical activation of triceps surae muscle remains altered at 3.5 years following open surgical repair of acute Achilles tendon rupture","volume":"29","author":"Wenning M","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_35_1","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1177\/03635465211019436","article-title":"Functional ankle range of motion but not peak Achilles tendon force diminished with heel\u2010rise and jumping tasks after Achilles tendon repair","volume":"49","author":"Zellers JA","year":"2021","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_36_1","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1136\/bjsports-2016-096106","article-title":"Return to play post\u2010Achilles tendon rupture: a systematic review and meta\u2010analysis of rate and measures of return to play","volume":"50","author":"Zellers JA","year":"2016","journal-title":"Br J Sports Med"},{"key":"e_1_2_13_37_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967119884071","article-title":"Defining components of early functional rehabilitation for acute Achilles tendon rupture: a systematic review","volume":"7","author":"Zellers JA","year":"2019","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_38_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.gaitpost.2019.02.027","article-title":"Changes in gait mechanics and muscle activity with wedge height in an orthopaedic boot","volume":"70","author":"Zellers JA","year":"2019","journal-title":"Gait Posture"},{"issue":"6","key":"e_1_2_13_39_1","first-page":"670","article-title":"Functional performance and tendon morphology after operative or nonoperative treatment of Achilles tendon ruptures","volume":"19","author":"Zhu S","year":"2024","journal-title":"Int J Sports Phys Ther"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70579","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ksa.70579","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70579","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:18:06Z","timestamp":1787314686000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.70579"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":38,"alternative-id":["10.1002\/ksa.70579"],"URL":"https:\/\/doi.org\/10.1002\/ksa.70579","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"assertion":[{"value":"2026-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ksa.70579"}}