Achilles tendon rupture

NewsBot · Mar 8, 2022

Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture
Annukka Saarensilta et al
Orthop J Sports Med. 2022 Feb 28;10(2):23259671221077679

Background: The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far been unknown.

Purpose: To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ between orthopaedic specialist surgeons and resident surgeons.

Study design: Cohort study; Level of evidence, 3.

Methods: We retrospectively analyzed data from 295 patients treated with surgical ATR repair with standardized techniques. The level of surgeon experience (specialist vs resident) and number of adverse events (rerupture, infection, and deep venous thrombosis) were recorded. Patient-reported and functional outcomes were assessed 12 months postoperatively using the validated Achilles tendon total rupture score (ATRS) and the heel-rise test, respectively. Analysis of covariance was used to compare differences in outcomes between specialist surgeons and resident surgeons. Pearson chi-square or Fisher exact test was used for analysis of adverse events.

Results: The mean ATRS at 12 months for patients operated on by resident surgeons was significantly higher compared with specialist surgeons (85.9 [95% CI, 80.3-91.5] vs 77.8 [95% CI, 73.8-81.9]; P = .028). In addition, the lateral difference (operated vs unoperated side) in mean total concentric work and number of heel-rise repetitions at 12 months was smaller in patients operated on by resident surgeons (P = .011 and 0.015, respectively). The number of adverse events did not differ significantly between the 2 groups.

Conclusion: Resident surgeons achieved patient-reported and functional outcomes at least as good as those of specialist surgeons in surgical ATR repair, with a similar risk of adverse events.
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NewsBot · Mar 11, 2022

Return to sports activities after flexor hallucis longus transfer for neglected Achilles tendon rupture
Jungtae Ahn, M.D., Ph.D. Bi O Jeong, M.D., Ph.D.
March 08, 2022

Transfer of the flexor hallucis longus (FHL) is known to be effective in the treatment of neglected Achilles tendon rupture (ATR). However, evidence on the return to sports activity levels and clinical outcomes is not sufficient. The aim of this study was assessing clinical outcomes and level of sports activity after FHL tendon transfer for treatment of neglected ATR. Twenty-eight patients who underwent FHL transfer for neglected ATR were analyzed retrospectively. Sports activity status was assessed using the Tegner Activity Scale (TAS). Clinical outcomes were evaluated using the Achilles tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. By the post hoc power analyses, the power level of more than 80% was identified. The pre-injury median TAS score was 4 point and unchanged at the last follow-up. The mean ATRSs and AOFAS Ankle-Hindfoot Scale scores at the last follow-up were 81 and 93, respectively. While the median TAS was unchanged, 9/28 patients suffered from lower activity level after the procedure. In conclusion, midterm results of FHL transfer for neglected ATR were shown to be favorable. The median TAS score was maintained. Nonetheless, 32% of patients returned to sports activities with a TAS score one point lower than that at pre-injury and with less favorable clinical outcomes.
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NewsBot · Mar 18, 2022

Effect of Surgeon Experience on Long-Term
Patient Outcomes in Surgical Repair of Acute
Achilles Tendon Rupture
Annukka Saarensilta,et al
Source

Background: The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far
been unknown.
Purpose: To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ
between orthopaedic specialist surgeons and resident surgeons.
Study Design: Cohort study; Level of evidence, 3.
Methods: We retrospectively analyzed data from 295 patients treated with surgical ATR repair with standardized techniques. The
level of surgeon experience (specialist vs resident) and number of adverse events (rerupture, infection, and deep venous thrombosis) were recorded. Patient-reported and functional outcomes were assessed 12 months postoperatively using the validated
Achilles tendon total rupture score (ATRS) and the heel-rise test, respectively. Analysis of covariance was used to compare differences in outcomes between specialist surgeons and resident surgeons. Pearson chi-square or Fisher exact test was used for
analysis of adverse events.
Results: The mean ATRS at 12 months for patients operated on by resident surgeons was significantly higher compared with
specialist surgeons (85.9 [95% CI, 80.3-91.5] vs 77.8 [95% CI, 73.8-81.9]; P ¼ .028). In addition, the lateral difference (operated vs
unoperated side) in mean total concentric work and number of heel-rise repetitions at 12 months was smaller in patients operated
on by resident surgeons (P ¼ .011 and 0.015, respectively). The number of adverse events did not differ significantly between the
2 groups.
Conclusion: Resident surgeons achieved patient-reported and functional outcomes at least as good as those of specialist surgeons in surgical ATR repair, with a similar risk of adverse events.
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NewsBot · Apr 4, 2022

Jigless knotless internal brace versus other minimal invasive Achilles tendon repair techniques in biomechanical testing simulating the progressive rehabilitation protocol
Po-Yen Ko, MD et al
Source

The jigless knotless internal brace surgery (JKIB), an alternative method for minimal invasive surgery (MIS) repair of acute Achilles tendon rupture, has advantages of preventing sural-nerve injury in MIS and superficial wound infection in open surgery, as previous clinical research demonstrates. However, no comparative study on the biomechanical performance between JKIB and other MIS techniques has been reported until now. In this study, fifty fresh porcine Achilles tendons were used to compare the JKIB with open surgery (two-stranded Krachow suture) with other MIS techniques, including Percutaneus Achilles Repair System (PARS), Speedbridge (SB), and Achillon Achilles Tendon Suture System (ACH), using a biomechanical testing with cyclic loading at 1 Hz. This test was used to simulate a progressive rehabilitation protocol where 20–100 N was applied in the first 250 cycles, followed by 20–190 N in the second 250 cycles, and then 20–369 N in the third 250 cycles. The cyclic displacement after 10, 100 and 250 cycles were recorded. The survived cycles were defined as a sudden drop in measured load. In survived cycles, the JKIB group (552.3 ± 72.8) had significantly higher cycles than the open, PARS, and ACH groups (204.3 ± 33.3, 395.9 ± 96.0, and 397.1 ± 80.9, respectively, p < 0.01) as analyzed by post hoc analysis, but no significant difference as compared with the SB group (641.6 ± 48.7). In cyclic displacement after 250 cyclic loadings, the JKIB group (11.29 ± 1.29) showed no significant difference as compared with PARS, SB, and ACH groups (12.21 ± 1.18, 9.80 ± 0.80, and 11.57 ± 1.10 mm, respectively) and significant less displacement than the open group (14.50 ± 1.85, p < 0.01). These findings suggest that JKIB could be an option for acute Achilles tendon repair in the MIS fashion due to no larger cyclic elongation compared with other MIS techniques.
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NewsBot · Apr 5, 2022

Return to Sports Activities After Flexor Hallucis Longus Transfer for Neglected Achilles Tendon Rupture
Jungtae Ahn, Bi O Jeong
J Foot Ankle Surg. 2022 Mar 9

Transfer of the flexor hallucis longus (FHL) is known to be effective in the treatment of neglected Achilles tendon rupture (ATR). However, evidence on the return to sports activity levels and clinical outcomes is not sufficient. The aim of this study was assessing clinical outcomes and level of sports activity after FHL tendon transfer for treatment of neglected ATR. Twenty-eight patients who underwent FHL transfer for neglected ATR were analyzed retrospectively. Sports activity status was assessed using the Tegner Activity Scale (TAS). Clinical outcomes were evaluated using the Achilles tendon total rupture score and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale. By the post hoc power analyses, the power level of more than 80% was identified. The preinjury median TAS score was 4 point and unchanged at the last follow-up. The mean Achilles tendon Total Rupture Scores and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale scores at the last follow-up were 81 and 93, respectively. While the median TAS was unchanged, 9/28 patients suffered from lower activity level after the procedure. In conclusion, midterm results of FHL transfer for neglected ATR were shown to be favorable. The median TAS score was maintained. Nonetheless, 32% of patients returned to sports activities with a TAS score 1 point lower than that at preinjury and with less favorable clinical outcomes.
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NewsBot · Apr 5, 2022

Jigless knotless internal brace versus other minimal invasive Achilles tendon repair techniques in biomechanical testing simulating the progressive rehabilitation protocol
Po-Yen Ko, MD et al
JFAS April 02, 2022

The jigless knotless internal brace surgery (JKIB), an alternative method for minimal invasive surgery (MIS) repair of acute Achilles tendon rupture, has advantages of preventing sural-nerve injury in MIS and superficial wound infection in open surgery, as previous clinical research demonstrates. However, no comparative study on the biomechanical performance between JKIB and other MIS techniques has been reported until now. In this study, fifty fresh porcine Achilles tendons were used to compare the JKIB with open surgery (two-stranded Krachow suture) with other MIS techniques, including Percutaneus Achilles Repair System (PARS), Speedbridge (SB), and Achillon Achilles Tendon Suture System (ACH), using a biomechanical testing with cyclic loading at 1 Hz. This test was used to simulate a progressive rehabilitation protocol where 20–100 N was applied in the first 250 cycles, followed by 20–190 N in the second 250 cycles, and then 20–369 N in the third 250 cycles. The cyclic displacement after 10, 100 and 250 cycles were recorded. The survived cycles were defined as a sudden drop in measured load. In survived cycles, the JKIB group (552.3 ± 72.8) had significantly higher cycles than the open, PARS, and ACH groups (204.3 ± 33.3, 395.9 ± 96.0, and 397.1 ± 80.9, respectively, p < 0.01) as analyzed by post hoc analysis, but no significant difference as compared with the SB group (641.6 ± 48.7). In cyclic displacement after 250 cyclic loadings, the JKIB group (11.29 ± 1.29) showed no significant difference as compared with PARS, SB, and ACH groups (12.21 ± 1.18, 9.80 ± 0.80, and 11.57 ± 1.10 mm, respectively) and significant less displacement than the open group (14.50 ± 1.85, p < 0.01). These findings suggest that JKIB could be an option for acute Achilles tendon repair in the MIS fashion due to no larger cyclic elongation compared with other MIS techniques.
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NewsBot · Apr 5, 2022

Application of wide-awake local anesthesia no tourniquet technique in the treatment of acute Achilles tendon rupture
Taoguang Wu et al
Randomized Controlled Trial Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Mar 15

Objective: To explore the value of wide-awake local anesthesia no tourniquet (WALANT) technique in the treatment of acute Achilles tendon rupture.

Methods: In a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair (CAMIR). There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization ( P>0.05). The operating room use time (from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale (NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society (AOFAS) at 12 months after operation.

Results: The operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group ( P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant ( t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups ( t=1.671, P=0.101); the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group ( t=-6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant ( t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups.

Conclusion: The application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.
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NewsBot · Apr 6, 2022

Intra-operative ultrasound: does it improve the results of percutaneous repair of acute Achilles tendon rupture?
Ahmed Mohamed Samy
Eur J Trauma Emerg Surg. 2022 Mar 11

Purpose: Percutaneous repair is a good option for acute Achilles tendon rupture. Although it overcomes the complications of open technique, it carries the risk of sural nerve injury and inadequate repair. In this study, we explore if the use of intra-operative ultrasound with percutaneous technique has any advantageous effect on final results of repair.

Methods: This is a prospective randomized study done between May 2014 and December 2020. It included 91 patients with complete acute Achilles tendon rupture distributed in 2 groups with homogenous clinical and demographic data. Group A (n = 47) included those managed by percutaneous repair with assistant of an intra-operative ultrasound. Group B (n = 44) included those done without the assistant of ultrasound. Post-operative evaluation was done clinically by the American Orthopedic Foot and Ankle Society score, calf muscle circumference and single heel rise test and radiologically by Magnetic Resonance Image.

Results: Patients of both groups reported continuous improvement of the American Orthopedic Foot and Ankle Society score with time. However, patient of group A recorded better functional outcome score at 3 months postoperatively. We recorded longer operative time in group A than those in group B. Continuous improvement of maximum calf circumference was observed in both groups. Satisfactory healing was noticed to happen faster in patients of group A than those of group B. We recorded two cases of re-rupture and two cases of sural nerve injury in group B with no reported complication in group A.

Conclusion: The use of an intra-operative ultrasound with percutaneous repair of acute rupture of Achilles tendon can improve the quality of repair as evidenced by quicker satisfactory healing and earlier regain of activity. Also, it can help in proper localization of sural nerve in relation to lateral edge of Achilles tendon
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NewsBot · Apr 7, 2022

Operative vs Nonoperative Treatment of Achilles Tendon Ruptures Using Early Functional Rehabilitation: Critical Analysis of Evidence
Aleksi Reito et al
Foot Ankle Int. 2022 Apr 5

Background: Nonoperative treatment with functional rehabilitation of Achilles tendon ruptures (ATRs) has become more common because of claim of "equivalent" risk of rerupture compared to operative treatment. We investigated how current evidence corroborates the often-claimed "equal" or "nondifferent" complication rates.

Methods: A search of meta-analyses in PubMed, CENTRAL, and Scopus was performed. Meta-analyses including randomized controlled trials (RCTs) comparing open operative repair of ATR and nonoperative treatment with functional rehabilitation regarding reruptures and other complications were identified.

Results: Four separate meta-analyses with 6 pooled treatment comparisons were identified. One of the 6 treatment effects (for risk ratio [RR]) showed a reduced risk of rerupture favoring operative treatment, whereas in the remaining analyses the null hypothesis assuming equal risk or an RR of 1 could not be rejected. The smallest RR (benefit in favor of surgery) that could be rejected based on the 95% CI was 0.28. The smallest risk difference that could be rejected in favor of surgery was 6.4%, indicating that nonoperative may have up to 6.4% higher rerupture rate. Treatment effects for complications other than rerupture had very large variability and imprecision.

Conclusion: The literature comparing surgery with nonoperative treatment using functional rehabilitation in ATR have been interpreted in favor of nonoperative treatment as the rerupture rates were falsely considered "equivalent." None of the published meta-analyses excluded a relative risk that is likely to affect the course of treatment in many cases. Increasing incidence of nonoperative treatment in ATRs is not clearly supported by current evidence.
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NewsBot · Apr 7, 2022

Biomechanical Comparison of Krackow Repair and Percutaneous Achilles Repair System for Achilles Tendon Rupture Fixation: A Cadaveric and Finite Element Analysis Study
Bonnie Macaluso et al
Foot Ankle Orthop. 2022 Mar 31;7(1)

Background: Open and percutaneous repair surgeries are widely used for the Achilles tendon rupture. However, prior biomechanic studies of these 2 approaches have mixed conclusions; therefore, we designed a cadaver and finite element (FE) model biomechanical study to compare the mechanical differences between the percutaneous Achilles repair system (PARS) and Krackow open repair under tensile load and rotation.

Methods: Sixteen Achilles tendons were extracted from fresh-frozen cadaver ankles and the calcaneums were fixed in mortar. A force control dynamic tensile mechanical test was performed at 1 Hz with 30- and 100-N cyclic loads. Initial intact baseline testing was followed by an incision on all Achilles tendons, 4 cm from the calcaneus insertion, which were then repaired using the PARS (n = 8) or Krackow (n = 8) method. Recorded force-displacement values were used to calculate mechanical parameters, and statistical significance of differences was determined by unpaired (between repair techniques) and paired (intact vs repaired) t tests. Material properties of the Achilles tendon in the FE model were modified and a 10-Nm flexion was simulated for intact and surgical groups.

Results: No differences were found between intact tendons assigned to PARS or Krackow repairs in Young's modulus (P = .582) and stiffness (P = .323). Pre- and postoperative Young's modulus was significantly decreased for both groups (Intact 230.60±100.76 MPa vs PARS 142.44±37.37 MPa, P < .012; Intact 207.46±81.12 MPa vs Krackow109.43±27.63 MPa, P < .002). Stiffness decreased significantly after surgery for both groups (Intact 25.33±10.89 N/mm vs PARS 6.51±1.68 N/mm, P < .003; Intact 20.30±8.65 N/mm vs Krackow 5.97±1.30 N/mm, P < .003). PARS ultimate tensile strength was significantly higher than the Krackow (PARS 280.29±47.32 N vs Krackow 196.97±54.28 N, P < .003) but not significantly different in the ultimate tensile strain. PARS had a significantly lower postoperative gap compared to Krackow (PARS 9.75±5.87 mm vs Krackow 25.19±7.72 mm, P < .001). FE analysis predicted an increased talocalcaneal contact pressure, maximum principal stress, and rotation in the Krackow vs PARS models, respectively.

Conclusion: Biomechanical parameters observed in this study through mechanical testing and FE analysis favor the selection of PARS over the Krackow repair based on better strength, higher failure force, and lower gap generation.Clinical Relevance: The study has analyzed two Achilles tendon repair methods using cadaver and numerical estimation and may help clinicians gain insight into selection of tendon repair approaches to generate better clinical outcomes.
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NewsBot · Apr 8, 2022

Operative vs Nonoperative Treatment of Achilles Tendon Ruptures Using Early Functional Rehabilitation: Critical Analysis of Evidence
Aleksi Reito, MD, PhD, Ville Mattila, MD, PhD, Teemu Karjalainen, MD, PhD
Foot & Ankle International April 5, 2022

Background:
Nonoperative treatment with functional rehabilitation of Achilles tendon ruptures (ATRs) has become more common because of claim of “equivalent” risk of rerupture compared to operative treatment. We investigated how current evidence corroborates the often-claimed “equal” or “nondifferent” complication rates.

Methods:
A search of meta-analyses in PubMed, CENTRAL, and Scopus was performed. Meta-analyses including randomized controlled trials (RCTs) comparing open operative repair of ATR and nonoperative treatment with functional rehabilitation regarding reruptures and other complications were identified.

Results:
Four separate meta-analyses with 6 pooled treatment comparisons were identified. One of the 6 treatment effects (for risk ratio [RR]) showed a reduced risk of rerupture favoring operative treatment, whereas in the remaining analyses the null hypothesis assuming equal risk or an RR of 1 could not be rejected. The smallest RR (benefit in favor of surgery) that could be rejected based on the 95% CI was 0.28. The smallest risk difference that could be rejected in favor of surgery was 6.4%, indicating that nonoperative may have up to 6.4% higher rerupture rate. Treatment effects for complications other than rerupture had very large variability and imprecision.

Conclusion:
The literature comparing surgery with nonoperative treatment using functional rehabilitation in ATR have been interpreted in favor of nonoperative treatment as the rerupture rates were falsely considered “equivalent.” None of the published meta-analyses excluded a relative risk that is likely to affect the course of treatment in many cases. Increasing incidence of nonoperative treatment in ATRs is not clearly supported by current evidence.
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NewsBot · Apr 8, 2022

Platelet-Rich Plasma in Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis☆
KhalisBokshMohamedElbashirOwainThomasPipDivallJitendraMangwani
The Foot; 16 March 2022, 101923

Highlights
•Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing.
•Limited conclusions on its effect on Achilles Tendon ruptures
•We performed a systematic review to look at all the literature in its effects
•PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes.
•However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy.
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Background
Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its clinical efficacy for acute Achilles tendon rupture are limited. We performed a systematic review and meta-analysis to investigate this and to compare to those without PRP treatment.

Methods
The Cochrane Controlled Register of Trials, Pubmed, Medline and Embase were used and assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (‘plasma’ OR ‘platelet-rich’ OR ‘platelet-rich plasma’ or ‘PRP’) AND (‘Achilles tendon rupture/tear’ OR ‘calcaneal tendon rupture/tear’ OR ‘tendo calcaneus rupture/tear’). Data pertaining to biomechanical outcomes (heel endurance test, isokinetic strength, calf-circumference and range of motion), patient-reported outcome measures (PROMs) and incidence of re-ruptures were extracted. Meta-analysis was performed for same outcomes measured in at least three studies. Pooled outcome data were analysed by random- and fixed-effects models.

Results
After abstract and full-text screening, 6 studies were included. In total there were 510 patients of which 256 had local PRP injection and 254 without. The average age was 41.6 years, mean time from injury to treatment 5.9 days and mean follow-up at 61 weeks. Biomechanically, there was similar heel endurance, isokinetic strength, calf circumference and range of motion between both groups. In general, there were no differences in patient reported outcomes from all scoring systems used in the studies. Both groups returned to their pre-injured level at a similar time and there were no differences on the incidence of re-rupture (OR 1.13, 95% CI, 0.46 to 2.80, p = 0.79).

Conclusion
PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes. However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy.
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NewsBot · Apr 10, 2022

Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques
Niklas Nilsson et al
Knee Surg Sports Traumatol Arthrosc. 2022 Apr 9

Purpose: Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re-ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps.

Method: Twenty-two patients (13 males and 9 females) with a median (range) age of 64 (34-73) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12 months post-operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel-rise height and repetitions together with tendon length determined by ultrasonography, concentric heel-rise power and heel-rise work.

Results: The patients reported a median (range) ATRS of 76 (45-99) out of 100. The median (range) ATRA on the injured side was 60° (49°-75°) compared with 49.5° (40-61°), p < 0.001, on the non-injured side. Eighteen out of 22 patients were able to perform a single-leg heel-rise on the non-injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel-rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non-injured side with a median (range) heel-rise repetitions of 11 (2-22) compared with 26 (2-27), (p < 0.001), and a median (range) heel-rise height of 5.5 cm (1.0-11.0 cm) compared with 9.0 cm (5.0-11.5 cm), (p < 0.001). The median calf circumference was 1.5 cm smaller on the injured side, 37.5 cm compared with 39 cm, when medians were compared. The median (range) tendon length of the injured side was 24.8 cm (20-28.2 cm) compared with 22 cm (18.4-24.2 cm), (p < 0.001), on the non-injured side.

Conclusion: The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re-ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel-rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction.
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NewsBot · Apr 13, 2022

Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques
Niklas Nilsson, Baldvin Gunnarsson, Michael R. Carmont, Annelie Brorsson, Jón Karlsson & Katarina Nilsson Helander
Knee Surgery, Sports Traumatology, Arthroscopy (2022)

Purpose
Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re-ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps.

Method
Twenty-two patients (13 males and 9 females) with a median (range) age of 64 (34–73) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12 months post-operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel-rise height and repetitions together with tendon length determined by ultrasonography, concentric heel-rise power and heel-rise work.

Results
The patients reported a median (range) ATRS of 76 (45–99) out of 100. The median (range) ATRA on the injured side was 60° (49°-75°) compared with 49.5° (40–61°), p < 0.001, on the non-injured side. Eighteen out of 22 patients were able to perform a single-leg heel-rise on the non-injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel-rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non-injured side with a median (range) heel-rise repetitions of 11 (2–22) compared with 26 (2–27), (p < 0.001), and a median (range) heel-rise height of 5.5 cm (1.0–11.0 cm) compared with 9.0 cm (5.0–11.5 cm), (p < 0.001). The median calf circumference was 1.5 cm smaller on the injured side, 37.5 cm compared with 39 cm, when medians were compared. The median (range) tendon length of the injured side was 24.8 cm (20–28.2 cm) compared with 22 cm (18.4–24.2 cm), (p < 0.001), on the non-injured side.

Conclusion
The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re-ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel-rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction.
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NewsBot · Apr 13, 2022

The Evaluation of Surgery Applied in Acute Achilles Tendon
Rupture with Subjective and Objective Data in Accordance
with Isokinetic Muscle Strength Measurement
Mehmet Yunus Timurtas
Source

Abstract; The aim of this study is to evaluate surgery performed due to acute Achilles tendon r upture in the
light of the subjective and objective data obtained from isokinetic muscle strength measurements. The study
included 25 patients with acute achilles tendon rupture. The surgical outcomes were evaluated with the AOFAS foot
and hindfoot evaluation score, and the data obtained with the Cybex isokinetic dynamometer. The mean AOFAS
foot and hindfoot evaluation score was 98.4 ± 3.7. In the scoring system developed by Thermann et al., the mean
value was 89.2 ± 6.8. Accordingly, 13 (52%) of the patients had excellent, 11 (44%) good and 1 (4%) moderate
results. In the subjective evaluation, 21 (84%) of the cases were evaluated as excellent, 3 (12%) as good and 1 (4%)
as fair. Calf circumference was measured as mean 38.8 ± 3.7 cm on the operated side and 39.8 ± 3.4 cm on the
contralateral side, and the difference was not considered statistically significant (p˃0.05). In the measurements
made with the isokinetic dynamometer, no significant difference was determined between the healthy and operated
sides in respect of the 30°/sec plantar flexion-dorsiflexion peak torque, 120°/sec plantar flexion peak torque and
total work measurements (p >0.05). The 120°/sec dorsiflexion peak torque value was found to be statistically
significantly higher in the operated ankle (p˂0.05). Although there is no consensus about the treatment protocol for
achilles tendon ruptures to be selected, considering the patient profile, methods that allow early active movement,
shorten the immobilization period, minimize the loss of work force, and increase patient satisfaction with a low
complication rate should be chosen. In this respect, open surgical procedures can be considered the most suitable
treatment method for achilles tendon ruptures.
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NewsBot · Apr 13, 2022

A Pop from a Shock: A Case Report of an
Unusual Cause of Achilles Tendon Rupture
Chia-Yuan Michael Lee, DO et al
Source

Introduction: Achilles tendon ruptures often occur during physical activity where the tendon is
frequently stressed. Although rare, rupture can also result from electric shock.
Case Report: We present the case of a 63-year-old female who presented with pain in the lower
leg after enduring an electric shock. She was diagnosed with a ruptured Achilles tendon based on
physical exam and ultrasound.
Conclusion: This case highlights an uncommon mechanism for a relatively common injury. Because
Achilles tendon ruptures are frequently misdiagnosed, clinicians need to be aware of unusual causes
and use tools at their disp
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NewsBot · Apr 14, 2022

Return-to-play and performance after operative treatment of Achilles tendon rupture in elite male athletes: a scoping review
Christopher M LaPrade et al
British Journal of Sports Medicine 2022;56:515-520.

Objective To examine the current evidence regarding return-to-play (RTP) and performance after Achilles tendon rupture in elite athletes treated with operative intervention.

Design Scoping review.

Data sources Published sources identified through a PubMed search of elite athletes, defined as professional or division one collegiate athletes in baseball, basketball, American football or soccer.

Methods Our search yielded a total of 2402 studies, with 13 studies fulfilling the study criteria of reporting elite athletes with objective measures of their athletic performance. A total of 709 elite athletes were included from the NBA, NFL, Major League Baseball (MLB), National Collegiate Athletic Association (NCAA) football and professional soccer.

Results and discussion Overall, 61%–100% of elite male athletes RTP after Achilles tendon rupture and operative repair. NBA players had inferior performance compared with their preoperative status as well as controls of non-injured players. Studies did not show significantly different performance after Achilles injury for MLB players. Professional soccer, NFL and NCAA football studies reported varying performance after injury.

Conclusions Evidence suggests that sports with explosive plantarflexion demands, such as basketball, may be associated with a greater decrease in performance despite operative intervention after Achilles rupture.
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NewsBot · Apr 14, 2022

No Difference in Return to Duty Between Minimally Invasive, Percutaneous Achilles Tendon Repair and Nonoperative Functional Rehabilitation in Active Duty Military Members
Jordan Tropf, Andres S. Piscoya, Alexander Lundy, ...
Foot & Ankle Orthopaedics April 9, 2022

Introduction/Purpose:
Achilles tendon ruptures are common injuries in the active duty US military population. Timely rehabilitation has critical importance in force readiness. There remains debate about optimal treatment of Achilles tendon ruptures. Recent studies have found decreased risk of rerupture but increased complication rates with operative management, with similar times to full recovery. The development of a minimally invasive, percutaneous Achilles tendon technique has shown lower rates of wound complications than open management, with similar re-rupture rates. However, there exists no comparative studies between the percutaneous, minimally invasive Achilles tendon surgery and nonoperative management. This was a retrospective cohort study comparing the results of the Percutaneous Achilles Repair System (PARS) and nonoperative management in the active duty military population.

Methods:
All Achilles tendon injuries in active duty patients were identified using the MHS system M2 from January 1, 2016 to December 31, 2020. Inclusion and exclusion criteria were applied and charts were reviewed. Demographic and treatment information were recorded. Time to return to duty, rerupture, complications, and deep vein thrombosis (DVT) were recorded and compared between each cohort. 47 patients met inclusion criteria with an average age of 38.7 years. There were 23 patients in the percutaneous operative group and 24 patients in the nonoperative group. Patients in the nonoperative group underwent regular functional rehabilitation supervised by a licensed physical therapist under the tri-service rehabilitation guidelines, based on the Willits protocol for nonoperative management (2010). 2 patients failed nonoperative management and underwent open Achilles reconstruction. They were excluded from the time to return to duty analysis. Demographics were described. There were no significant differences in group demographics.

Results:
There was no difference in time to return to duty in the nonoperative and percutaneous Achilles tendon repair (160.5 days, 5.35 months vs 161.7 days, 5.39 months) cohorts (p=0.47). No patient failed to return to duty due to treatment of an Achilles rupture. There were no DVTs in either group. There was 1 wound complication (infection) (4.3%) and 3 instances of postoperative paresthesias (2 sural, 1 peroneal) 13% in the operative cohort. 2 patients failed nonoperative management (reruptured Achilles tendon) and underwent open reconstruction with flexor halluces longus augmentation (8%). The operative cohort had a higher rate of complications (17.3% vs 8.3%, p=0.42, OR=2.11, CI= (0.34, 12.86)), although this was not statistically significant. There were no reruptures in the operative cohort.

Conclusion:
There was no difference in time to return to duty in the nonoperative and percutaneous Achilles tendon repairs. There was a higher rate of reruptures in the nonoperative group. Percutaneous operative treatment had a higher risk of complications. There were no failures in the operative cohort. The final decision on management of acute Achilles tendon ruptures should be based on specific patient factors and shared decision to return military members back to duty as quickly as possible. Prospective or well designed randomized controlled trials are necessary in the future to better delineate outcomes between nonoperative and percutaneous Achilles rupture management.
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NewsBot · Apr 14, 2022

Minimally Invasive Achilles Tendon Repair Confers Faster
Recovery and Reduced Complications Compared to Open
Achilles Tendon Repair
Akshay Padki et al
Journal of Foot and Ankle Surgery (Asia Pacific) (2022): 10.5005/jp-journals-10040-1190

Current literature shows that minimally invasive (MIS) tendo-Achilles (TA) repairs carry a lower risk of infection compared to open repairs. Our
study aimed to assess whether MIS TA repair also contributed to improved patient outcomes as well as lowered infection and wound complication
rates. Between January 2017 and December 2019, 19 patients underwent minimally invasive TA repairs performed by two fellowship-trained foot
and ankle surgeons at a tertiary institution. A retrospective review of registry data was performed. Outcomes were measured to include AOFAS
Score, RAND36 Scores as well as patient-reported satisfaction scores and visual analog scale (VAS) for pain assessment. Statistical analysis was
performed using a Student’s t-test for continuous variables and Pearson’s Chi-squared test for categorical variables. The overall results showed
that patients who underwent MIS TA repair had much faster recovery when compared to traditional open TA repairs. Of the 19 patients who
underwent MIS TA repair, there were two cases of superficial wound infection compared to six in the open group (p < 0.05). The MIS TA repair
arm of the study also had higher patient-reported satisfaction rates, lower VAS pain scores (p < 0.05), with better AOFAS and SF36 quality of life
measures. Overall, the rate of superficial infection, wound complication and length of stay were all reduced in the MIS group with similar deep
infection rates. Our study concludes that where possible, TA rupture should be repaired minimally invasively and by an experienced foot and
ankle surgeon as this will yield the best outcomes for the patient.
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NewsBot · Apr 16, 2022

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture
Ståle B. Myhrvold, M.D., Espen F. Brouwer, M.D., Tor K. M. Andresen, M.D., Karin Rydevik, P.T., M.Sc., Madeleine Amundsen, M.D., Wolfram Grün, M.D., Faisal Butt, M.D., Morten Valberg, Ph.D., Svend Ulstein, M.D., Ph.D., and Sigurd E. Hoelsbrekken, M.D., Ph.D.
N Engl J Med 2022; 386:1409-1420

BACKGROUND
Whether surgical repair of an acute Achilles’ tendon rupture by an open-repair or minimally invasive approach is associated with better outcomes than nonsurgical treatment is not clear.

METHODS

We performed a multicenter, randomized, controlled trial that compared nonoperative treatment, open repair, and minimally invasive surgery in adults with acute Achilles’ tendon rupture who presented to four trial centers. The primary outcome was the change from baseline in the Achilles’ tendon Total Rupture Score (scores range from 0 to 100, with higher scores indicating better health status) at 12 months. Secondary outcomes included the incidence of tendon rerupture.

RESULTS
A total of 554 patients underwent randomization, and 526 patients were included in the final analysis. The mean changes in the Achilles’ tendon Total Rupture Score were −17.0 points in the nonoperative group, −16.0 points in the open-repair group, and −14.7 points in the minimally invasive surgery group (P=0.57). Pairwise comparisons provided no evidence of differences between the groups. The changes from baseline in physical performance and patient-reported physical function were similar in the three groups. The number of tendon reruptures was higher in the nonoperative group (6.2%) than in the open-repair or minimally invasive surgery group (0.6% in each). There were 9 nerve injuries in the minimally invasive surgery group (in 5.2% of the patients) as compared with 5 in the open-repair group (in 2.8%) and 1 in the nonoperative group (in 0.6%).

CONCLUSIONS
In patients with Achilles’ tendon rupture, surgery (open repair or minimally invasive surgery) was not associated with better outcomes than nonoperative treatment at 12 months.
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NewsBot · Apr 17, 2022

Outcomes of Single Stage Repair of Open Tear of Achilles Tendon
MUDASSAR NAZAR et al
P J M H S Vol. 16, No.02, FEB 2022

Objective: To determine the outcome of debridement and repair of open achilles tendon tear in a single setting.
Material and Methods: In this study, we included 30 patients who presented with open tendon rupture. The study was
conducted from June 2021 to Dec 2021 in Islam Medical College Sialkot and CMH Lahore. Each injury was treated with
appropriate debridement and primary repair using Pennington's variation of Kessler's approach. Surgery was performed in a
single sitting, with the paratenon closed circumferentially and plantaris reinforcement applied when an end-to-end repair couldn't
be obtained. Cast was applied below knee for two months. Weight bearing was started at end of three months.
Results: Among the 30 patients in this series, all were male with a median age of 37 years and range 18-68 years. The
commonest source of injury was agriculture fields in 14 (46.7%) cases, road traffic accidents in 10 (33.3%) cases, play grounds
in 4 (13.3%) and Pakistani toilet in 2 (6.7%) case. At 6 months follow-up, there was not a single case of wound infections or
wound dehiscence. Mild restriction of range of motion was diagnosed in 23 (76.7%) patients, moderate in 4 (13.3%) patients
and severe in 3 (10%) cases.
Conclusion: Early debridement and proper repair of the ruptured tendon are critical in the treatment of an open tendoachilles
tear. Soft tissue handling and a modified Kessler approach with additional circumferential suturing and paratenon closure
provide appropriate strength to the repaired tendon.
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NewsBot · Apr 17, 2022

Utilizing A Percutaneous Versus Open Achilles Tendon Repair Technique for Treating Acute Achilles Tendon Ruptures in Physically Active Adults: A Critically Appraised Topic
in Journal of Sport Rehabilitation
Arhum Saleem et al
12 Apr 2022

Clinical Scenario: Acute Achilles tendon ruptures can be devastating injuries with the potential to significantly alter an individual’s ability to perform functional activities. Given the rise in the incidence of acute Achilles tendon ruptures, it is important to determine whether percutaneous versus open Achilles tendon repair facilitates superior outcomes. Clinical Question: In physically active adults with an acute Achilles tendon rupture, does performing percutaneous Achilles tendon repair result in improved outcomes compared with open Achilles tendon repair? Summary of Key Findings: Percutaneous Achilles tendon repair has similar efficacy as open Achilles tendon repair in facilitating return to activity/sport, and demonstrates improvement in short-term functional outcomes with potentially lower wound complication rates. Clinical Bottom Line: Evidence supports the utilization of percutaneous Achilles tendon repair in physically active adult patients with acute Achilles tendon ruptures. It is important to critically review the benefits, risks, and alternatives of each treatment option based on patient characteristics. In addition, postoperative expectations should be discussed with the patient to set appropriate goals for recovery and improve overall satisfaction. Strength of Recommendation: A grade B recommendation can be made based on “fair” to “good” evidence from 2 level 2b studies and 1 Level 1b study to support the utilization of percutaneous Achilles tendon repair techniques.
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NewsBot · Apr 18, 2022

THE EFFECT OF DIFFERENT TIMING OF MECHANICAL STRESS TO THE HEALING TENDON AFTER ACHILLES TENDON RUPTURE IN MICE
M. Yoneno et al
Source

Purpose: Early weight-bearing and range-of-motion exercises are recommended in the postoperative rehabilitation of Achilles tendon ruptures. In fundamental research, it has been found that mechanical stress on tendons during the remodeling phase of the tendon healing process promotes collagen rearrangement. However, inappropriate mechanical stress to the tendon has been reported to inhibit tendon healing. The amount of mechanical stress to the tendon has been associated with the degree of regenerative healing. There is no clear evidence on the appropriate timing and amount of ankle motion to promote tendon healing. Eliasson et al. (2006) reported that mechanical stress on a postoperative day 14 accelerated tendon healing in rats, but they used conditions without muscle contraction. The effect of joint range-of-motion exercises commonly performed in clinical practice on tendon healing and degeneration is unknown. Thus, this study aimed to determine the effect of the different timing of starting exercise on tendon healing using static stretching in mice.
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NewsBot · Apr 19, 2022

Application of wide-awake local anesthesia no tourniquet technique in the treatment of acute Achilles tendon rupture
Wu Tn et al
Chinese Journal of Reparative and Reconstructive Surgery, 01 Mar 2022, 36(3):279-283Language:chi

Objective
To explore the value of wide-awake local anesthesia no tourniquet (WALANT) technique in the treatment of acute Achilles tendon rupture.
Methods
In a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair (CAMIR). There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization ( P>0.05). The operating room use time (from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale (NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society (AOFAS) at 12 months after operation.
Results
The operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group ( P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant ( t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups ( t=1.671, P=0.101); the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group ( t=-6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant ( t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups.
Conclusion
The application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.
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NewsBot · Apr 21, 2022

Workflow assessing the effect of Achilles tendon rupture on gait function and metatarsal stress: Combined musculoskeletal modeling and finite element analysis
Dong Sun, Yang Song, Xuanzhen Cen, ...
Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine March 19, 2022

Achilles tendon rupture (ATR) incidence has increased among badminton players in recent years. The foot internal stress was hard to obtain through experimental testing. The purpose of the current research is to develop a methodology that could improve the finite element model derived foot internal stress prediction for ATR clinical and rehabilitation applications. A subject-specific musculoskeletal model was combined with a 3D finite element model to predict the metatarsal stress. The 80% point during the push-off phase of walking was selected for the comparing between injured and uninjured sides. The surgical repaired Achilles tendon (AT) after 12 months was elongated by 5.5% than the uninjured tendon. At 80% point of stance phase, the ankle plantarflexion angle and AT force decreased by 39.6% and 21.9% on the injured side, respectively. The foot inversion degree increased by 22.9% and was accompanied by the redistribution of metatarsals von Mises stress. The stresses on the fourth and fifth metatarsals were increased by 59.5% and 85.9% on the injured side. The workflow is available to assess musculoskeletal disorders and obtain foot internal stress after ATR. The decreased ankle plantar flexor force may be affected by triceps surae muscle atrophy and weakened force transmission ability of elongated AT. The increased von Mises stress on fourth and fifth metatarsals accompanied by higher foot inversion may increase the ankle lateral sprain injury risk.
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NewsBot · Apr 21, 2022

V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type Ⅲ chronic Achilles tendon rupture
Feiyu Cai et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Apr 15;36(4):410-414

Objective: To investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect.

Methods: Between February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation.

Results: The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05).

Conclusion: V-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.
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NewsBot · Apr 24, 2022

Biomechanical Comparison of Knotless Suture Anchor Versus Percutaneous End-to-End Technique for Mid-Substance Achilles Tendon Rupture Repair
Colin P Murphy et al
J Foot Ankle Surg. 2022 Apr 1

Percutaneous Achilles tendon repairs can be performed with 2 distal fixation techniques: knotless suture anchor repair (KL) or percutaneous end-to-end repair (ETE). There is a paucity of literature comparing the biomechanical strength of these 2 distal fixation techniques. The aim of this study was to compare the strength of KL and ETE repairs using flat-braided suture for mid-substance Achilles tendon rupture during simulated progressive rehabilitation. Nine matched pairs of fresh-frozen below-knee cadaveric extremities were randomly assigned into these 2 repair groups. Each specimen was tested in 2 parts sequentially; Part I simulating passive ankle range of motion (cyclic: 20N-100N), and Part II simulating ambulation in a walking boot (cyclic: 20N-190N). The number of cycles, gap displacement, and the mode of failure were recorded for each repair. Achilles tendon repairs using the percutaneous methods of ETE and KL techniques showed no significant difference in the number of cycles to clinical failure, mean gap displacement, or overall failure rate. During Part I, the survival rate in terms of clinical failure for KL and ETE groups was 8 of 9 repairs and 7 of 9 repairs, respectively. During Part II, all repairs experienced clinical failure in both groups. Five repairs in the KL group experienced suture anchor pull out from the calcaneus, and 3 repairs failed at suture-tendon interface. Four repairs in the ETE group failed due to knot slippage and 5 repairs failed at suture-tendon interface. Both techniques are viable options in treating acute mid-substance Achilles tendon ruptures.
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NewsBot · Apr 24, 2022

Rates of complications in Achilles tendon rupture repair using absorbable and nonabsorbable suture material; A systematic review
Aoife A Feeley et al
Foot (Edinb). 2021 Nov 3

Background: The impact of suture type on tensile strength, re-rupture rates and infection risk in Achilles tendon rupture repair is not been well established. The aim of this review is to evaluate existing literature on the associated risk of postoperative infection with absorbable and non-absorbable suture materials in Achilles tendon rupture repair.

Methods: A systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications associated with Achilles tendon rupture repair. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare rupture rates and infections following rupture repair.

Results: 12 studies with a total of 460 patients, 230 in both nonabsorbable and absorbable suture groups were included for analysis. Risk of wound complications was significantly higher in patients with non-absorbable sutures (p < 0.001).

Conclusion: Nonabsorbable braided sutures is associated with the highest risk of postoperative wound complications following Achilles tendon rupture repair.
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NewsBot · May 16, 2022

Chronic Achilles Tendon Rupture
– Perspectives on outcomes after
surgical treatment and rehabilitation
Anna Nordenholm
Department of Health and Rehabilitation
Institute of Neuroscience and Physiology
Sahlgrenska Academy
University of Gothenburg
Sweden, 2022

Chronic Achilles tendon rupture (CATR) is a rupture of the Achilles tendon for
which adequate diagnosis and treatment has been delayed after index injury. In this
thesis defined as 4 weeks or more. The delay is commonly due to a misdiagnosis
by the assessing healthcare professional or because of patient delay. Compared
with acute Achilles tendon ruptures (ATR), which have been extensively studied
in the recent years, CATRs are to date significantly less researched. Moreover,
there is a widespread use of non-validated outcome measurements in the existing
literature.
The purpose of this thesis was to determine the outcomes of surgical treatment
and postoperative rehabilitation in patients with a CATR from a broad perspective,
including several validated outcome measurements. The thesis includes both
quantitative and qualitative research methods, and comprises 5 studies evaluating
objective and subjective foot and ankle related function, patient experiences, and
economic cost.
Study I, a case series, evaluated the 1-year postoperative outcomes and found that
the level of recovery varies greatly between individuals. Persistent limitations in
subjective foot and ankle function were found and the majority of patients had
returned to a light to moderate physical activity level. In terms of calf muscle
endurance, some patients recovered well while others had deficits up to 30%
to 50% compared with the healthy side. Moreover, an elongation of the injured
tendon was found compared with the healthy tendon.
In Study II, gait biomechanics were evaluated preoperatively and 1-year
postoperatively. Postoperative gait biomechanics was then compared with a
healthy control group. Power development in the ankle and knee joint during
gait was significantly improved at the 1-year follow-up compared with the
preoperative gait. There were persistent impairments in gait biomechanics
compared with healthy controls.
Study III investigated the relationship between calf muscle endurance, gait
biomechanics and tendon elongation at 1 year postoperatively. Greater calf
muscle endurance was found to be related to better gait biomechanics, especially
to power development in the ankle joint. Moreover, the results indicated that less
tendon elongation may be related to greater calf muscle endurance.
Study IV, a qualitative interview study, investigated patient experiences related to
sustaining, undergoing treatment for and recovering from a CATR, at 4-6 years
after surgical treatment. The patients described a traumatic or non-traumatic
injury mechanism that resulted in persistent weakness in the foot/ankle that did
not improve over time. Receiving the correct diagnosis was a relief, but realizing
that the treatment had been delayed due to themself or a healthcare professional
initially misinterpreting the injury was frustrating. The patients expressed an
overall satisfaction with outcomes, however, some had adjusted their physical
activities due to a fear of re-rupture.
In Study V, the healthcare costs and production loss costs of patients surgically
treated for CATR were evaluated and compared with the costs of patients treated
non-operatively or operatively for an ATR. Furthermore, the study evaluated the
preoperative and 1-year postoperative patient-reported foot and ankle function.
The study concluded that the healthcare costs were significantly higher for patients
treated for a CATR compared with patients treated for an acute ATR, irrespective
of treatment. In terms of total costs, surgical treatment of patients with a CATR
was more expensive compared with non-surgical treatment of patients with an
acute ATR. Patient-reported function was significantly increased postoperatively
compared to the preoperative scores.
Taken together, at 1 year postoperatively, significant deficits in subjective and
objective function are found in patients with a CATR. Gait biomechanics can
be significantly improved compared with the preoperative gait, however not
necessarily normalized. Delay of treatment can be a negative experience for the
patient and leads to greater healthcare costs compared with an early treatment. This
thesis contributes with valuable new findings to the currently very limited state of
knowledge in the field. To be able to answer more specific research questions on
patients with a CATR, such as predictors of outcome, there is a need for further
studies with larger sample sizes that uses validated outcome measurements.
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NewsBot · May 16, 2022

Comparative analysis of Achilles tendon healing outcomes after open tenotomy versus percutaneous tenotomy: An experimental study in rats
Jae H. Song,Chan Kang,Seung Y. Han,Won H. Park,Min H. Kim,Ji H. Moon,Jung Y. Tae,Hyeon Y. Park,In H. Yoo,Jong H. Park,Yong H. Yeo,Dae Y. Kim
09 August 2021

There is growing interest in conservative treatment of Achilles tendon rupture. However, the majority of experimental studies of Achilles tendon have been performed by open tenotomy. More appropriate model of conservative treatment of Achilles tendon rupture is required. We performed an experimental study to evaluate whether outcomes differ between open tenotomy and percutaneous tenotomy of the Achilles tendon in rats. The Achilles tendons of 48 rats were transected. The animals were divided into two groups according to surgical technique: open tenotomy or microscopy-assisted percutaneous tenotomy. After 1, 2, and 4 weeks, functional, biomechanical, and histological analyses were performed. Western blot was performed for quantitative molecular analysis at 1 week. The Achilles functional index was superior in the percutaneous tenotomy group, compared with the open tenotomy group, at 1 week. The cross-sectional area was significantly larger in the percutaneous tenotomy group than in the open tenotomy group at 4 weeks. Relative to the native tendons, load to failure and stiffness yielded comparable results at 2 weeks in the percutaneous tenotomy group and at 4 weeks in the open tenotomy group. The histological score was significantly better in the percutaneous tenotomy group than in the open tenotomy group at 1 week. At 1 week, interleukin-1β expression in the open tenotomy group was higher than in the percutaneous tenotomy group. In summary, Achilles tendon healing was substantially affected by the tenotomy method. We presume that our percutaneous tenotomy method might constitute a useful experimental animal model for conservative treatment of Achilles tendon rupture.
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NewsBot · May 17, 2022

Achilles Tendon Tears in Adolescents and Young Adults
Dennis E. Kramer, MD, Jennifer J. Beck, MD, Ryan M. Sanborn, BA, ...
Orthopaedic Journal of Sports Medicine May 13, 2022

Background:
Achilles tendon tears are rare in adolescents and young adults, and management of these injuries remains controversial.

Hypothesis/Purpose:
To describe long-term limitations and physical activity levels following full or partial Achilles tears in adolescents and young adults, and report rates of surgical management, complications, re-tears, and time to return to sports (RTS).

Methods:
We conducted a descriptive study of young patients (8-22 years old) who were treated for a partial or full Achilles tear at two pediatric hospitals between 2004-2018. Demographic, imaging, and treatment data were retrospectively collected. Patient reported outcomes were obtained including the Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Tegner Activity Scale (TAS), and separate questions about reinjury and return to sport.

Results:
Of the 41 eligible patients with Achilles injuries, 25 (61%; mean age 18.9 years; 40% male) had a minimum one year of follow-up data and were further analyzed. Twenty-three patients (92%) underwent surgical repair. Twenty patients (80%) returned questionnaires at a median 6.3 years (IQR, 3.4 to 9.7 years), while the other 5 patients were followed for a median of 1.8 years (IQR, 1.1 to 2.5 years). Twenty-two (88%) injuries were full tears, 53% (10/19) with reported location occurring mid-tendon. Median ATRS score was 96 (IQR, 82-100) and median TAS score was 6 (4-8). Median FAOS scores were excellent for symptoms (91), pain (100), ADL (100), and sports (98), and were good for QOL (88). The 6-month RTS probability was 47% (95% CI, 19-66%) and at 12 months was 95% (65-99%). The median time to RTS for partial tears was 5.6 months vs. 6.6 months for full tears (p=0.05). One surgical patient (4%) had a retear which required revision repair while 2 others needed additional surgery (1 - arthroscopy for ankle impingement, 1 - surgery for haglund’s deformity). In addition to the 3 surgical patients requiring re-operation, 8 patients experienced other complications (11/25 total complications, 44%), which included minor wound/scar complications (4), scar formation necessitating hydrodissection (1), Achilles tendonitis (2), and persistent pain following conservative treatment leading to surgical repair (1). Females were more likely to experience a complication (9/15, 60%) compared to males (2/10, 20%), but this difference was not statistically significant (p=0.10).

Conclusion:
Adolescents and young adults surgically treated for an Achilles injury reported satisfactory long-term outcomes.
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NewsBot · May 17, 2022

A narrative review of Achilles tendon ruptures in racket sports
Elin Larsson
INTERNATIONAL JOURNAL OF RACKET SPORTS SCIENCE

This review aims to enlighten the existing research about Achilles tendon ruptures (ATR) in racket sports. Further, this review will also include the acute management, rehabilitation, treatment and prognosis of an ATR. ATR is a common injury among individuals playing racket sports. However, the literature is limited and not up to date. Previous research claims that up to 70 percent of all ATR is related to sports activities where racket sports dominate. A large number of patients sustaining an ATR return to sport within a year from injury.
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NewsBot · May 17, 2022

In vivo localised gastrocnemius subtendon representation within the healthy and ruptured human Achilles tendon
Raad M. Khair, Lauri Stenroth, Neil J. Cronin, Aleksi Reito, Juha Paloneva, and Taija Finni
12 MAY 2022

The Achilles tendon (AT) is composed of three distinct in-series elastic subtendons, arising from different muscles in the triceps surae. Independent activation of any of these muscles is thought to induce sliding between the adjacent AT subtendons. We aimed to investigate displacement patterns during voluntary contraction (VOL) and selective transcutaneous stimulation of medial (MGstim) and lateral (LGstim) gastrocnemius between ruptured and healthy tendons, and to examine the representative areas of AT subtendons. Twenty-eight patients with unilateral AT rupture performed bilateral VOL at 30% of the maximal isometric un-injured plantarflexion torque. AT displacement was analysed from sagittal B-mode ultrasonography images during VOL, MGstim and LGstim. Three-way ANOVA revealed a significant two-way interaction of contraction type*location on the tendon displacement (F(10-815)=3.72, p<0.001). The subsequent two-way analysis revealed a significant contraction type*location interaction for tendon displacement (F(10-410)=3.79, p<0.001) in the un-injured limb only, where LGstim displacement pattern was significantly different from MGstim (p=0.008) and VOL (p=0.005). When comparing contraction types between limbs the there were no difference in the displacement patterns, but displacement amplitudes differed. There was no significant difference in the location of maximum or minimum displacement between limbs. The displacement pattern was not different in non-surgically treated compared to un-injured tendons one-year post rupture. Our results suggest that near the calcaneus, LG subtendon is located in the most anterior region adjacent to medial gastrocnemius. However, free tendon stiffness seems to be lower in the injured AT, leading to more displacement during electrically-induced contractions compared to the un-injured.
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NewsBot · May 21, 2022

Greater heel-rise endurance is related to better gait biomechanics in patients surgically treated for chronic Achilles tendon rupture
Anna Nordenholm et al
Knee Surg Sports Traumatol Arthrosc. 2022 May 20

Purpose: To determine the relationships among calf muscle function, tendon length and gait biomechanics in patients surgically treated for chronic Achilles tendon rupture.

Methods: Twenty-one patients with chronic Achilles tendon rupture (mean age 62 ± 13 years) were evaluated by heel-rise endurance test, Achilles Tendon Resting Angle (ATRA), ultrasound measurement of tendon length and three-dimensional gait analysis. A bivariate two-sided correlation test was performed on all variables in all patients.

Results: Better performance across all parameters of the heel-rise endurance test correlated with faster walking speed (r = 0.52-0.55), greater peak ankle power (r = 0.56-0.64), shorter stance phase (r = -0.52 to -0.76) and less peak ankle dorsiflexion angle (r = -0.49 to -0.64) during gait. Greater ATRA correlated with longer stance time (r = 0.47), greater peak ankle dorsiflexion angle (r = 0.48), less heel-rise repetitions (r = -0.52) and less heel-rise total work LSI (r = -0.44 to -0.59).

Conclusion: Greater calf muscle endurance, especially heel-rise total work, is moderately correlated (r = 0.49-0.76) to better ankle biomechanics during gait in patients surgically treated for CATR. The heel-rise endurance test may be a clinical proxy for power development in the ankle joint during gait.
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NewsBot · May 30, 2022

Panda rope bridge technique versus open repair of acute Achilles tendon rupture: A comparative clinical study
KaiyingTangZhiboDengTingWangXiandingSunLiangjunYinMaoNie
Injury 24 May 2022

Purpose
The treatment options of acute Achilles tendon rupture (AATR) remain controversial. This article aims to compare the efficacy of a new surgical procedure, the panda rope bridge technique (PRBT) with open surgery of AATR.

Methods
Ninety-eight patients with AATR were recruited, 53 underwent the PBRT, and 45 underwent open surgery. The operation time, postoperative American Orthopaedic Foot and Ankle Score, Achilles Tendon Rupture Score, complications and time to return to work and restore exercise were documented.

Results
The average operation time, intraoperative blood loss and complication rate were 35.1 min, 18.2 ml and 3.8%, respectively, in the PRBT group, which were significantly lower than those of the open surgery group (P<0.001). The post-operative American Orthopaedic Foot and Ankle Score of 99.6 and the Achilles Tendon Rupture Score of 97.5 in the PRBT group were significantly higher than that of the open surgery group (P<0.001). The time to return to work and return to exercise were shorter in the PRBT group (P<0.001).

Conclusion
Compared to open surgery, PRBT is a better approach to the management of AATR. PRBT offers accelerated recovery, lower occurrence of post-operative complications and improved recovery of ankle joint function.
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NewsBot · Jun 5, 2022

Achilles Tendon Repairs: Identification of Risk Factors for and Economic Impact of Complications and Reoperation
Nikunj N. Trivedi, MD, Kunal Varshneya, BS, J. Blake Calcei, BS, ...
Sports Health: A Multidisciplinary Approach May 29, 2022

Background:
Compared with nonoperative management, Achilles tendon repair is associated with increased rates of complications and increased initial healthcare cost. However, data are currently lacking on the risk factors for these complications and the added healthcare cost associated with common preoperative comorbidities.

Hypothesis:
Identify the independent risk factors for complications and reoperation after acute Achilles tendon repair and calculate the added cost of care associated with having each preoperative risk factor.

Study Design:
Retrospective cohort study.

Level of evidence:
Level 3.

Methods:
A retrospective review of a large commercial claims database was performed to identify patients who underwent primary operative management for Achilles tendon rupture between 2007 and 2016. The primary outcome measures of the study were risk factors for (1) postoperative complications, (2) revision surgery, and (3) increased healthcare resource utilization.

Results:
A total of 50,279 patients were included. The overall complication rate was 2.7%. The most common 30-day complication was venous thromboembolism (1.2%). The rate of revision surgery was 2.5% at 30 days and 4.3% at 2 years. Independent risk factors for 30-day complications in our cohort included increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Independent risk factors for revision surgery within 2 years included female sex, tobacco use, hypertension, obesity, and the presence of any postoperative complication. The average 5-year cost of operative intervention was $17,307. The need for revision surgery had the largest effect on 5-year overall cost, increasing it by $6776.40. This was followed by the presence of a postoperative complication ($3780), female sex ($3207.70), and diabetes ($3105).

Conclusion:
Achilles tendon repair is a relatively low-risk operation. Factors associated with postoperative complications include increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Factors associated with the need for revision surgery include female sex, hypertension, obesity, and the presence of any postoperative complication. Female sex, diabetes, the presence of any complication, and the need for revision surgery had the largest added costs associated with them.

Clinical Relevance:
Surgeons can use this information for preoperative decision-making and during the informed consent process
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NewsBot · Jun 7, 2022

Arthroscopic treatment of acute closed noninsertional rupture of Achilles tendon
Y J Hao et al
Zhonghua Wai Ke Za Zhi. 2022 Jun 1;60(6):540-545

Objective: To investigate the clinical efficacy of arthroscopic treatment of acute closed noninsertional rupture of Achilles tendon. Methods: The clinical and imaging data of 30 patients (30 feet) with acute closed noninsertional rupture of Achilles tendon who were treated with all-inside arthroscopic technique at the Department of Hand and Foot Microsurgery,Xuzhou Central Hospital from June 2018 to June 2020 were analyzed retrospectively. There were 26 males and 4 females,aged (38.3±8.5)years old(range:19 to 66 years). There were 22 cases on the right side and 8 cases on the left side. The duration from injury to surgery was (2.1±1.4) days (range:1 to 7 days).All patients were treated with all-inside arthroscopic technique.The function of the ankle and the foot was assessed using visual analogue scale (VAS),the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale and the Achilles tendon total rupture score (ATRS). The Arner-Lindholm score system was used to evaluate the excellent and good rate of clinical effect. Paired sample t test or rank-sum test was used for data comparison. Results: The patients were followed up for (18.6±2.2)months(range:12 to 28 months).All the wounds healed at the first stage.No complication such as infection,sural nerve injury or re-rupture happened.Two patinets felt mild pain after a long time exercise, and were alleviated by microwave therapy and stretching the Achilles tendon consistently.Another patient was unable to do a sustained single stance heel raise,which was recovered after repeated function practice.At the last follow-up,the VAS (M(IQR)) decreased from 6(5) preoperatively to 0(1)(Z=6.512,P<0.01),the AOFAS ankle hindfoot scale improved from 60.6±8.3 preoperatively to 96.3±4.8(t=-29.774,P<0.01),and the ATRS improved from 61.7±7.8 preoperatively to 97.1±2.3 (t=-53.661,P<0.01).According to the Arner-Lindholm score system,27 cases were excellent,3 cases were good,and the excellent and good rate was 100%. Conclusions: The all-inside arthroscopic technique not only ensures the quality of tendon ananstomosis,but also avoids injury to the sural nerve.It has the advantages of small trauma,faster recovery and fewer complications.
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NewsBot · Jun 8, 2022

Efficacy of Stem Cell Therapy on Achilles Tendon Rupture Repair
Alex Dang, B.S., Harsh Varshney, B.S., Douglas Weng, B.S.
Extremitas

Objective: The purpose of this literature review was to assess the efficacy of the studies encompassing the following
question of if there is a positive correlation between the use of stem cells and Achilles tendon rupture recovery.
Methods: Studies included in this review were held to criteria matching the study of mesenchymal stem cells (MSC)
relating to tendon repair. The study focused on the development of MSC as a viable treatment modality to injury. As
a literature review correlating data from multiple studies on potential indications and contraindications of use, only
peer-reviewed studies were used. Studies collected were then cross-referenced to find support from other peer
reviewed sources. To focus the review on the topic of efficacy and not detractors such as questions of morality and
legality, studies on the latter topics are referenced but excluded in this discussion.
Results: The use of MSC in the progression of tendon rupture recovery is shown in a multitude of studies. However,
opposing research also exists that shows a lack of definitive means to direct the development of stem cells into the
specific tissues needed.
Conclusion: The general consensus seems to show a lack of definitive correlation between stem cell use and
improvement in Achilles tendon recovery leading to limitations in the implementation of its use.
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NewsBot · Jun 11, 2022

Outcomes of Percutaneous Achilles Repair Compared With Endoscopic Flexor Hallucis Longus Tendon Transfer to Treat Achilles Tendon Ruptures
Nasef Mohamed N. Abdelatif, MD, PhD, Jorge Pablo Batista, MD
Foot & Ankle International June 10, 2022

Background:
Both percutaneous and endoscopically assisted methods are reported to produce good results in the surgical management of acute Achilles tendon ruptures. The aim of this retrospective study was to compare between a percutaneous method and a recently described isolated endoscopically assisted flexor hallucis longus (FHL) transfer method as surgical means of management in patients with acute Achilles tendon ruptures.

Methods:
One hundred seventeen patients were included in the current study and divided into 2 groups: 59 patients who underwent percutaneous Achilles repair (PAR Group) and 58 patients who underwent isolated endoscopic FHL transfer (FHL Group) were compared. Patients were clinically evaluated using American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture Score (ATRS), and Achilles tendon resting angle (ATRA) measures. In addition, ankle plantarflexion power, FHL dynamometry, Tegner activity levels, and return to previous levels of activity were also documented for all patients.

Results:
Nine months after surgery, patients in the FHL transfer group were more likely to be able to return to normal activities (91% vs 73%, P < .01). Thirty months after surgical treatment, we found no difference in ATRS, AOFAS, ATRA, ankle plantarflexion strength, or Tegner activity scores between study groups. Overall complications were reported in 6 patients in the FHL group (10.3%) and in 8 patients in the PAR group (13.6%). No major neurovascular or skin complications were encountered.

Conclusion:
The current study demonstrated satisfactory and comparable results and complications when comparing isolated endoscopic FHL tendon transfer or percutaneous Achilles tendon repairs in the surgical management of acute Achilles tendon ruptures.
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NewsBot · Jun 11, 2022

Outcomes of Percutaneous Achilles Repair Compared With Endoscopic Flexor Hallucis Longus Tendon Transfer to Treat Achilles Tendon Ruptures
Nasef Mohamed N Abdelatif, Jorge Pablo Batista
Foot Ankle Int. 2022 Jun 10

Background: Both percutaneous and endoscopically assisted methods are reported to produce good results in the surgical management of acute Achilles tendon ruptures. The aim of this retrospective study was to compare between a percutaneous method and a recently described isolated endoscopically assisted flexor hallucis longus (FHL) transfer method as surgical means of management in patients with acute Achilles tendon ruptures.

Methods: One hundred seventeen patients were included in the current study and divided into 2 groups: 59 patients who underwent percutaneous Achilles repair (PAR Group) and 58 patients who underwent isolated endoscopic FHL transfer (FHL Group) were compared. Patients were clinically evaluated using American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture Score (ATRS), and Achilles tendon resting angle (ATRA) measures. In addition, ankle plantarflexion power, FHL dynamometry, Tegner activity levels, and return to previous levels of activity were also documented for all patients.

Results: Nine months after surgery, patients in the FHL transfer group were more likely to be able to return to normal activities (91% vs 73%, P < .01). Thirty months after surgical treatment, we found no difference in ATRS, AOFAS, ATRA, ankle plantarflexion strength, or Tegner activity scores between study groups. Overall complications were reported in 6 patients in the FHL group (10.3%) and in 8 patients in the PAR group (13.6%). No major neurovascular or skin complications were encountered.

Conclusion: The current study demonstrated satisfactory and comparable results and complications when comparing isolated endoscopic FHL tendon transfer or percutaneous Achilles tendon repairs in the surgical management of acute Achilles tendon ruptures.
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Achilles tendon rupture

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