{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:43:57Z","timestamp":1785372237072,"version":"3.55.0"},"reference-count":54,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/100007308","name":"Arthrex GmbH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007308","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007308","name":"Arthrex GmbH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007308","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The biarticular anatomy of the gastrocnemii is an important mechanism of knee\u2013ankle coupling and differential elongation may affect this function leading to weakness of the push\u2010off phase during the gait. Achilles tendon ruptures may cause detachment of the gastrocnemius tendon from the soleus aponeurosis with subsequent differential elongation of the individual subtendons. This study investigated the effects of such detachment by investigating tendon fusion levels of the two muscle groups, and the effect of sequential differential elongation of the gastrocnemius on the Achilles tendon resting angle (ATRA) and to the knee\u2013ankle coupling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Conjoined tendon length (CTL) was measured in 23 cadavers. ATRA in knee extension (ATRA 0) and 90\u2010degree knee flexion (ATRA 90) was measured with the gastrocnemius tendons (GT) intact, transected and with the gap reduced in 5\u2010mm increments. In 15 specimens, knee\u2013ankle coupling was examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Considerable anatomical variation was present with CTL ranging from 2 to 40% of fibular length. In the intact triceps, surae ATRA 0 differed from ATRA 90 by 6 degrees (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Cutting the gastrocnemius caused an immediate separation of the tendon ends by 19\u00a0mm. ATRA 0 and ATRA 90\u00a0increased 8 and 4 degrees (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), significantly larger increase for ATRA 0 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Lengthening the gastrocnemius 10\u00a0mm altered the coupling point 10 degrees towards dorsiflexion. Transfixing the gastrocnemius at the level of the gap where the Achilles was sectioned, decoupled the knee\u2013ankle coupling in all but two specimens. A moderate correlation between CTL and length of the medial gastrocnemius tendon was found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A greater relative ATRA 0 than relative ATRA 90\u00a0indicates differential elongation of the gastrocnemius. By elongating the gastrocnemius the knee\u2013ankle coupling point shifts dorsally, and 20\u00a0mm elongation completely decouples the knee\u2013ankle coupling. Independent lengthening of the gastrocnemius may explain the loss of power experienced by some patients following acute Achilles tendon rupture despite what would appear to be appropriate approximation of the ruptured tendon ends. Recognizing this occurrence is crucial when treating Achilles tendon ruptures and such patients require surgical correction in order to avoid long\u2010term weakness of push\u2010off strength.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00167-021-06580-1","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T04:24:38Z","timestamp":1620015878000},"page":"2535-2544","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Loss of the knee\u2013ankle coupling and unrecognized elongation in Achilles tendon rupture: effects of differential elongation of the gastrocnemius tendon"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4136-7119","authenticated-orcid":false,"given":"Susanne Olesen","family":"Schaarup","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Naestved Hospital Ringstedgade 61 4700 Naestved Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Wetke","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedics Zealand University Hospital Koege Lykkebaekvej 1 4600 Koege Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Aage Glud","family":"Konradsen","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedics IOC Centre of Bispebjerg Hospital Bispebjerg Bakke 23 2400 Copenhagen NV Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James David Forbes","family":"Calder","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Fortius Clinic 17 Fitzhardinge Street W1H 6EQ London UK"},{"name":"<!--<label>5<\/label>--> Department of Bioengineering Imperial College London Exhibition Rd, South Kensington SW7 2BU London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,30]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/10255842.2015.1032943"},{"issue":"7","key":"e_1_2_11_3_2","first-page":"532","article-title":"Individual muscle contributions to the in vivo Achilles tendon force","volume":"13","author":"Arndt 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Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-021-06580-1","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-021-06580-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1007\/s00167-021-06580-1","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06580-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-021-06580-1","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T03:19:29Z","timestamp":1773631169000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-021-06580-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,30]]},"references-count":54,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1007\/s00167-021-06580-1"],"URL":"https:\/\/doi.org\/10.1007\/s00167-021-06580-1","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,30]]},"assertion":[{"value":"19 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest<b>.<\/b>","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual particiapants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}