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Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture
  1. Md Abdul Alim1,
  2. Simon Svedman1,
  3. Gunnar Edman2,
  4. Paul W Ackermann1,3
  1. 1Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
  3. 3Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Dr Paul W Ackermann; paul.ackermann{at}


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.

  • Chronic
  • Collagen
  • Injuries
  • Tendon
  • Achilles

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