Anatomic variations of the musculotendinous junction of the soleus muscle and its clinical implications

The soleus muscle, like the gastrocnemius, is a powerful plantarflexor muscle in the lower limb. The soleus muscle joins the aponeurosis of the gastrocnemius muscle to form the calcaneal (Achilles) tendon. While the basic anatomy of the soleus muscle has been previously described, no study has addressed the anatomical variations of its distal attachment. We found considerable anatomic variation in the distance between this musculotendinous junction and the most proximal point of the proximal edge. This distal measuring point was defined as the most proximal point of the proximal edge of the posterior surface of the calcaneal tuberosity. Eighty human cadaver specimens were preserved according to Thiel's method; we examined one limb from each cadaver, studying 80 lower extremities in total. Following careful dissection of the lower limb, we measured the distance between the distal point of attachment of the soleus muscle fibers (the musculotendinous junction) and the designated measuring point. Our findings were divided into three groups: Group 1 (10 cases, 12.5%), where the distance between the musculotendinous junction and the designated point on the calcaneal tuberosity was between 0 and 1 inches; Group 2 (56 cases, 70%), where the distance was between 1 and 3 inches; and Group 3 (14 cases, 17.5%), where the distance was greater than 3 inches. Detailed knowledge of the anatomic variations of the soleus muscle at its insertion point onto the calcaneal tendon has clinical implications in calcaneal tendon repair following rupture and in the planning of reconstructive surgery using soleus muscle flaps.     

Structure of the Achilles tendon at the insertion on the calcaneal tuberosity

Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius (LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in each type. We look forward to elucidating the mechanisms generating insertional Achilles tendinopathy in future biomedical studies based on the present results.     

The Effect of the Achilles Tendon on Trabecular Structure in the Primate Calcaneus

Humans possess the longest Achilles tendon relative to total muscle length of any primate, an anatomy that is beneficial for bipedal locomotion. Reconstructing the evolutionary history of the Achilles tendon has been challenging, in part because soft tissue does not fossilize. The only skeletal evidence for Achilles tendon anatomy in extinct taxa is the insertion site on the calcaneal tuber, which is rarely preserved in the fossil record and, when present, is equivocal for reconstructing tendon morphology. In this study, we used high‐resolution three‐dimensional microcomputed tomography (micro‐CT) to quantify the microstructure of the trabecular bone underlying the Achilles tendon insertion site in baboons, gibbons, chimpanzees, and humans to test the hypothesis that trabecular orientation differs among primates with different tendon morphologies. Surprisingly, despite their very different Achilles tendon lengths, we were unable to find differences between the trabecular properties of chimpanzee and human calcanei in this specific region. There were regional differences within the calcaneus in the degree of anisotropy (DA) in both chimpanzees and humans, though the patterns were similar between the two species (higher DA inferiorly in the calcaneal tuber). Our results suggest that while trabecular bone within the calcaneus varies, it does not respond to the variation of Achilles tendon morphology across taxa in the way we hypothesized. These results imply that internal bone architecture may not be informative for reconstructing Achilles tendon anatomy in early hominins. Anat Rec, 296:1509–1517, 2013. © 2013 Wiley Periodicals, Inc.     

The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study

The source of pain and the background to the pain mechanisms associated with mid-portion Achilles tendinopathy have not yet been clarified. Intratendinous degenerative changes are most often addressed when present. However, it is questionable if degeneration of the tendon itself is the main cause of pain. Pain is often most prominent on the medial side, 2-7cm from the insertion onto the calcaneus. The medial location of the pain has been explained to be caused by enhanced stress on the calcaneal tendon due to hyperpronation. However, on this medial side the plantaris tendon is also located. It has been postulated that the plantaris tendon might play a role in these medially located symptoms. To our knowledge, the exact anatomy and relationship between the plantaris- and calcaneal tendon at the level of complaints have not been anatomically assessed. This was the purpose of our study. One-hundred and seven lower extremities were dissected. After opening the superficial fascia and paratendon, the plantaris tendon was bluntly released from the calcaneal tendon moving distally. The incidence of the plantaris tendon, its course, site of insertion and possible connections were documented. When with manual force the plantaris tendon could not be released, it was defined as a 'connection' with the calcaneal tendon. In all specimens a plantaris tendon was identified. Nine different sites of insertion were found, mostly medial and fan-shaped onto the calcaneus. In 11 specimens (10%) firm connections were found at the level of the calcaneal tendon mid-portion. Clinical and histological studies are needed to confirm the role of the plantaris tendon in mid-portion Achilles tendinopathy.     

The functional anatomy of Kager's fat pad in relation to retrocalcaneal problems and other hindfoot disorders

Kager's fat pad is a mass of adipose tissue occupying Kager's triangle. By means of a combined magnetic resonance imaging, ultrasound, gross anatomical and histological study, we show that it has three regions that are closely related to the sides of the triangle. Thus, it has parts related to the Achilles and flexor hallucis longus (FHL) tendons and a wedge of fat adjacent to the calcaneus. The calcaneal wedge moves into the bursa during plantarflexion, as a consequence of both an upward displacement of the calcaneus relative to the wedge and a downward displacement of the wedge relative to the calcaneus. During dorsiflexion, the bursal wedge is retracted. The movements are promoted by the tapering shape of the bursal wedge and by its deep synovial infolds. Fibrous connections linking the fat to the Achilles tendon anchor and stabilize it proximally and thus contribute to the motility of its tip. We conclude that the three regions of Kager's fat pad have specialized functions: an FHL part which contributes to moving the bursal wedge during plantarflexion, an Achilles part which protects blood vessels entering this tendon, and a bursal wedge which we suggest minimizes pressure changes in the bursa. All three regions contribute to reducing the risk of tendon kinking and each may be implicated in heel pain syndromes.     

Intra-articular calcaneal fracture in a 14-year-old competing skier: case report

Intra-articular calcaneal fracture as a skiing injury in children is extremely rare. We report on what we believe is a unique and previously unreported mechanism of a skiing injury, which caused intra-articular calcaneal fracture in a young competing skier, a member of the Croatian national ski team. This 14-year-old boy sustained a heel injury while training for giant slalom. There was no fall on the heel or obvious axial force that could have caused this type of calcaneal fracture. The skier had sophisticated equipment and used carving skies. We speculated that, when the skier tried to establish the lost balance during the fall, a violent contraction of triceps muscle occurred. Instead of an injury of a well-protected tuber or Achilles tendon, the strong pulling force of the Achilles tendon was transmitted more distally and anteriorly, generating axial compression force, which caused an intra-articular fracture of the calcaneus bone. Obviously, the existing ski boot did not sufficiently protect the calcaneus bone. We postulate that the calcaneal tuber and Achilles tendon were protected on the expense of the intra-articular calcaneal fracture. Our case warns of the possibility of a serious foot injury in young top skiers in spite of extensive improvement in the ski equipment. Sophisticated carving skis could be a contributing factor to an injury.     

骨质疏松患者股骨头不同区域骨结构与生物力学分析

目的探讨老年股骨颈骨折病人的股骨头样本各个区域的结构和生物力学性能差异,研究不同区域显微结构和生物力学特征及其对内固定物的影响。方法收集20个老年股骨颈骨折病人关节置换术后股骨头标本,以股骨头表面解剖标志点为参照,将股骨头按平分方法分为外侧、内侧、中间三部分。确定环钻的位置和钻取方向,用环钻于不同区域钻取直径10 mm、高10 mm圆柱形松质骨柱。通过Micro-CT系统扫描分析,分析不同区域内松质骨柱数据,包括骨体积分数(BVF)、骨小梁间隙(Tb.Sp)、骨小梁厚度(Tb.Th)、骨小梁数目(Tb.N)、骨表面积体积比(BS/BV)、结构模型指数(SMI)。应用微有限元计算不同区域骨组织的力学差异。结果老年股骨头颈内骨质含量下降,显微结构和生物力学性能区域变化明显,中间区域的骨结构和力学性能明显优于内侧和外侧。结论股骨头中间部位骨骼结构和力学强度明显优于内侧和外侧,在临床治疗骨质疏松股骨颈骨折的时候需要充分考虑内固定的部位。     

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

The Achilles tendon is the most frequently ruptured tendon in the lower limb and accounts for almost 20% of all large tendon injuries. Despite numerous published studies describing its blood supply, there has been no uniformity in describing its topography. The current study comprises a detailed anatomical study of both the intrinsic and extrinsic arterial supply of the Achilles tendon, providing the detail sought from studies calling for improved planning of surgical procedures where damage to the vascularity of the Achilles tendon is likely. A dissection, microdissection, histological, and angiographic study was undertaken on 20 cadaveric lower limbs from 16 fresh and four embalmed cadavers. The Achilles tendon is supplied by two arteries, the posterior tibial and peroneal arteries. Three vascular territories were identified, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. The midsection of the Achilles tendon was markedly more hypovascular that the rest of the tendon. The Achilles tendon is at highest risk of rupture and surgical complications at its midsection. Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and approaches to the tendon operatively should consider the route of supply by the peroneal artery to this susceptible part of the tendon. Clin. Anat. 22:377–385, 2009. © 2009 Wiley‐Liss, Inc.     

改良膝降动脉为蒂大收肌腱骨皮瓣修复跟腱复合组织缺损

目的　探讨改良膝降动脉为蒂的大收肌腱骨皮瓣修复跟区跟腱复合组织缺损方法及效果。 方法　对3例外伤致足跟区跟腱止点伴跟骨及皮肤软组织缺损的患者,采用以膝降动脉为蒂的隐动脉穿支皮瓣修复跟区皮肤缺损,以膝降动脉关节支为蒂的大收肌腱骨瓣移植修复跟区复合组织缺损。其中跟区皮肤缺损面积为7 cm×9 cm～5 cm×7 cm ,跟腱缺损长度为6～8 cm,切取皮瓣面积为8 cm×10 cm～6 cm×8 cm ,大收肌腱切取长度为7～9 cm。 结果　3例复合组织瓣全部顺利成活,术后随访6～12个月,皮瓣感觉恢复S3～4,双足提踵试验及单足提踵试验均阴性,步态恢复均正常。 结论　应用隐动脉穿支设计皮瓣,皮瓣设计于大腿内侧, 改良了隐动脉皮瓣设计于小腿内侧,造成切口过大,分离血管蒂较长等缺点,疗效可靠,是目前较理想修复方法。     

The “safe zone” in medial percutaneous calcaneal pin placement

Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot. foot. Clin. Anat. 22:523–529, 2009. © 2009 Wiley‐Liss, Inc.     

跟外侧动脉的显微外科解剖

目的探讨跟外侧动脉的起始、行程、分支和分布等情况,为临床实践提供解剖学资料。方法在12侧经股动脉灌注红色乳胶溶液的成人下肢标本上,对跟外侧动脉进行显微外科解剖,观察其出现率并测量其起始位置、起始处及穿深筋膜处的口径。以外踝尖为基点,对外踝尖上6 cm范围内每2 cm间隔内跟外侧动脉分支的蒂长和口径进行测量并作统计学分析。另取小腿动脉血管造影标本5例,进一步观察跟外侧动脉行程及其与跟腱表面皮瓣血供的关系。结果跟外侧动脉于外踝尖上4.9～9.4(6.56±1.30)]cm处源自腓动脉,起始处口径为1.0～3.3(1.78±0.60)mm,穿深筋膜处口径为0.44～2.0(0.81±0.40)mm。其全程呈"L"型,垂直段共有2～5(2.50±0.80)支分支。在外踝尖上0.00～2.00、2.01～4.00、4.01～6.00 cm间隔内,分支的蒂长和口径分别是:(0.81±0.31)、(1.68±0.55)、(1.59±0.41)cm和(0.80±0.31)、(0.80±0.11)、(0.85±0.23)mm。垂直段分支分支纵、橫穿行,纵者吻合成链状与腓肠神经及小隐静脉伴行,参与腓肠神经营养血管皮瓣供血系统的组成,橫行者越过跟腱浅面与来自胫后动脉的分支吻合,供养跟腱区皮瓣;水平段分支3～5支,分布于足外侧面后侧约1/3皮肤软组织。结论跟外侧动脉是腓动脉的直接延续,尸体标本和活体标本中跟外侧动脉出现率分别为100%和80%;跟外侧动脉既参与腓肠神经营养血管皮瓣供血系统的组成,又营养跟腱表面的皮瓣。     

跟外侧动脉穿支皮瓣的应用解剖

目的　探讨跟腱区及跟部皮肤软组织的血供解剖学,为跟外侧动脉穿支皮瓣的临床应用提供解剖学基础。 方法　16侧经红色乳胶灌注的成人下肢标本,解剖观察跟外侧动脉“垂直段”及其穿支血管的位置、口径、数目及分布规律。 结果　位于小腿后骨筋膜鞘深部的腓动脉于外踝尖上(6.6±1.1) cm ( 5.5~9.4 cm) 发出腓动脉前穿支和跟外侧动脉,跟外侧动脉下行穿出分隔小腿后骨筋膜鞘浅、深部之小腿后筋膜隔到达外踝后间隙,于腓骨肌腱与跟腱之间移行,继续绕外踝向前下方分布。小腿下段腓动脉、跟外侧动脉穿支数为(3.6±0.7)支,口径为（0.9±0.29） mm,营养跟腱区及跟部皮肤软组织。 结论　研究结果显示跟腱区及跟部皮肤软组织的血供主要来源于腓动脉、跟外侧动脉,为跟外侧动脉的命名、临床应用以及小腿中下段皮瓣的设计和跟部手术提供解剖学基础。     

Tendon entheses of the human masticatory muscles

Tendons attach to the limb skeleton via chondral-apophysary or periosteal-diaphysary entheses. It was the aim of the present study to investigate the tendon entheses of the temporal, the masseter, as well as the medial and lateral pterygoid muscles, considering the biomechanics and the mode of osteogenesis at the attachment sites. The origin and insertion zones of the four masticatory muscles were studied histologically and by polarization light microscopy in six halves of human heads. Contrary to the limb skeleton no causal relationship between the histological structure of the tendon entheses and the osteogenic mode of the bone areas involved was observed in the masticatory muscles that were studied. Based on the histological findings, a purely structural classification of the tendon attachments irrespective of the osteogenesis is therefore proposed that is applicable to the entire skeleton. It is possible to distinguish between tendon entheses inserting into periosteum, into bone or into fibrocartilage. Tendon attachments with periosteal insertion are found at the temporal plane, the retromolar triangle, zygomatic arch, lateral pterygoid plate, in the caudal zone of the pterygoid fovea of the neck of mandible as well as major portions of the ramus and angle of the mandible. The attachment zones in which collagen fibrils of tendons insert into the bone via the periosteum correspond in their structure to plane periosteal-diaphysary insertions into the diaphyses of long bones. Attachment zones to the bone are present at the inferior temporal line, the base of the coronoid process, the caudal surface of the zygomatic arch, the cranial zones of the pterygoid fovea of the neck of the mandible as well as at circumscribed areas of the ramus and angle of the mandible. In these zones the collagen fibers of the tendon insert immediately into the bone without any mediation of other tissues. The entheses resemble those of circumscribed periosteal-diaphysary attachments to long bones. Fibrocartilaginous entheses occur at the coronoid process, the cranialmost portions of the pterygoid fovea of the neck of the mandible as well as in circumscribed areas of the medial and lateral facets of the angle of the mandible. The structures of these attachment sites are comparable to chondral-apophysary tendon attachments. As for masticatory muscles, the described forms of tendon entheses occur at the same time in the majority of the attachment sites. From the structure of the three types of tendon entheses it is possible to conclude that they fulfill a biomechanical function similar to that of the limb skeleton, namely adapting the different elasticity moduli of bone and tendon tissues. From a technical perspective they can be considered to act as an "angle and stretching brake".     

Dissecting the accessory soleus muscle: a literature review, cadaveric study, and imaging study

The accessory soleus muscle (ASM) has been an unusual anatomical variant since its first recordings in Guy's Hospital Reports of the early nineteenth century. Individuals with an ASM may present with symptoms of pain and/or swelling and were often misdiagnosed as soft-tissue tumors such as hemangioma, sarcoma, or lipoma. The aim of our study was threefold: (1) to review the cadaveric and clinical literature to determine the reported prevalence of ASM; (2) to conduct a cadaveric study investigating the prevalence and attachment sites of the ASM; (3) to conduct a retrospective analysis of magnetic resonance imaging (MRI) of patients presenting with ankle symptoms to determine prevalence and attachment sites of the ASM. Our findings demonstrated that the prevalence of the muscle (3%) was as stated in the literature (0.7-5.5%), but with males more likely to possess unilateral ASM and females more likely to possess bilateral ASM. Three common attachment types were reported in the literature: (i) a distal attachment to the medial aspect of the calcaneus by a separate tendon (26.1% of ASM subjects), (ii) a distal tendinous attachment to the calcaneal tendon (3.5%), and (iii) a distal fleshy attachment to the medial surface of the calcaneus (4.3%), with the remaining 66.1% of ASM subjects from previous studies with unidentified attachment types. Our cadaveric specimens were found to possess each attachment type, whereas imaging patients all possessed distal attachments to the medial calcaneus via a separate tendon. Furthermore, a rare cadaveric specimen with two distal attachments was also found. We believe it is important to recognize the prevalence of this condition and be aware of its morphology in order to understand its clinical presentation, accurately diagnose the condition, and pursue effective forms of management.     

Achilles tendon: the 305th anniversary of the French priority on the introduction of the famous anatomical eponym

This article presents a detailed chronology regarding the development of terminology relating to the calcaneal tendon, from ancient times to modern day nomenclature. The notable contributions of Flemish anatomist Philip Verheyen, French surgeon Jean-Louis Petit, German anatomist and surgeon Lorenz Heister, along with the actual origin of the famous anatomical eponym “Achilles tendon” are analysed. During the study of the aforementioned authors, it was revealed that the term was first adopted, in its original French form, by J.-L. Petit in 1705 and later in 1717, in its Latin form, by L. Heister.     

The twisted structure of the rat Achilles tendon

The rat is frequently used as a model to study the characteristics, aetiology and pathology of the Achilles tendon. However, though the structure of the human Achilles tendon has been extensively investigated, the anatomical structure of the rat Achilles tendon remains unclear, which impedes the ability to use rats to study Achilles tendinopathy. The purpose of this study was to reveal the structure of the rat Achilles tendon and to explore its similarities with the human Achilles tendon through an anatomical dissection of 80 rat Achilles tendons (40 female, 40 male). This study found that the subtendons of the rat Achilles tendon originating from the triceps surae muscle were twisted, and each subtendon also had its own torsion. The extent of these two types of torsion could be very different between rats. Alterations in this torsion may result in distinct stress fields in the Achilles tendon, which may play a critical role in the pathogenesis of Achilles tendinopathy. This study provides an important basis to support the use of rats as model animals to investigate the characteristics of the human Achilles tendon and Achilles tendinopathy.     

Tendon entheses of the human masticatory muscles

Tendons attach to the limb skeleton via chondral-apophysary or periosteal-diaphysary entheses. It was the aim of the present study to investigate the tendon entheses of the temporal, the masseter, as well as the medial and lateral pterygoid muscles, considering the biomechanics and the mode of osteogenesis at the attachment sites. The origin and insertion zones of the four masticatory muscles were studied histologically and by polarization light microscopy in six halves of human heads. Contrary to the limb skeleton no causal relationship between the histological structure of the tendon entheses and the osteogenic mode of the bone areas involved was observed in the masticatory muscles that were studied. Based on the histological findings, a purely structural classification of the tendon attachments irrespective of the osteogenesis is therefore proposed that is applicable to the entire skeleton. It is possible to distinguish between tendon entheses inserting into periosteum, into bone or into fibrocartilage. Tendon attachments with periosteal insertion are found at the temporal plane, the retromolar triangle, zygomatic arch, lateral pterygoid plate, in the caudal zone of the pterygoid fovea of the neck of mandible as well as major portions of the ramus and angle of the mandible. The attachment zones in which collagen fibrils of tendons insert into the bone via the periosteum correspond in their structure to plane periosteal-diaphysary insertions into the diaphyses of long bones. Attachment zones to the bone are present at the inferior temporal line, the base of the coronoid process, the caudal surface of the zygomatic arch, the cranial zones of the pterygoid fovea of the neck of the mandible as well as at circumscribed areas of the ramus and angle of the mandible. In these zones the collagen fibers of the tendon insert immediately into the bone without any mediation of other tissues. The entheses resemble those of circumscribed periosteal-diaphysary attachments to long bones. Fibrocartilaginous entheses occur at the coronoid process, the cranialmost portions of the pterygoid fovea of the neck of the mandible as well as in circumscribed areas of the medial and lateral facets of the angle of the mandible. The structures of these attachment sites are comparable to chondral-apophysary tendon attachments. As for masticatory muscles, the described forms of tendon entheses occur at the same time in the majority of the attachment sites. From the structure of the three types of tendon entheses it is possible to conclude that they fulfill a biomechanical function similar to that of the limb skeleton, namely adapting the different elasticity moduli of bone and tendon tissues. From a technical perspective they can be considered to act as an ”angle and stretching brake”. Accepted: 29 March 2000     

带线锚钉材料在跟腱断裂修复中的应用

背景：带线锚钉材料修复跟腱断裂较传统可吸收线编织法具有操作简单、固定可靠、生物力学强度大的优势。 目的：观察应用带线锚钉材料修复跟腱断裂的临床效果。 方法：选择急性跟腱断裂患者30例,根据患者自愿原则采取两种方法修复跟腱,实验组采用带线锚钉材料以编织法行断端缝合,对照组采用可吸收缝线以编织法行断端缝合。随访1年观察患者足踝功能修复效果。 结果与结论：实验组足踝功能、跖屈肌力、患者满意度明显优于对照组(P < 0.05)。表明带线锚钉材料可更好修复跟腱断裂,保护踝关节功能。