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1 Bispebjerg Hospital, Institute of Sports Medicine and University of Copenhagen, Denmark
2 Bispebjerg hospital, Institute of Sports Medicine and University of Copenhagen, Copenhagen, Denmark
3 Bispebjerg Hospital, Institute of Sports Medicine and University of Copenhagen, Denmark; Insitute of Sports Science and Clinical Biomechanics, University of Southern Denmark, DK-5230, Odense; Denmark, Denmark
4 Bispebjerg Hospital, Department of radiology, Copenhagen, Denmark
* To whom correspondence should be addressed. E-mail: hl02{at}bbh.regionh.dk.
The aim of the present study was to analyse how human tendon connective tissue responds to a ~7 week period of immobilization and a remobilization period of a similar length, in patients with unilateral ankle fracture, which is currently unknown. Calf muscle cross sectional area (CSA) decreased by 15% (5316 to 4517 mm2) and strength by 54% (239 to 110 Nm) in the immobilized leg after 7 weeks. During the 7-week remobilization the CSA increased by 9% (to 4943 mm2) and strength by 37% (to 176 Nm). Achilles tendon CSA did not change significantly during either immobilization or remobilization. Local collagen turnover was measured as the peritendinous concentrations of PINP and ICTP, markers thought to be indices of type I collagen synthesis and degradation, respectively. Both markers increased (PINP; 21 to 257 ng/ml. ICTP; 2.1 vs. 9.8 µg/l (compared to control leg)) after the 7 weeks of immobilization, and levels decreased again during the recovery period (PINP; to 103 ng/ml. ICTP; 1.9 vs. 4.2 µg/l (compared to control leg)). A significant reduction in calf muscle CSA and strength was found in relation to 7 weeks of immobilization. Immobilization increased both collagen synthesis and degradation in tendon near tissue. However, it can not be excluded that the facture of the ankle in close proximity could have affected these data. Remobilization increased muscle size and strength and tendon synthesis and degradation decreased to baseline levels. These dynamic changes in tendon connective tissue turnover were not associated with macroscopic changes in tendon size.
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