Achilles tendon rupture

NewsBot · Aug 9, 2023

Ultrasonographic Finding of Contralateral Achilles Tendon in Patients With Acute Achilles Tendon Rupture: A Prospective Observational Study
Park, Young Hwan MD; Kim, Woon MD; Choi, Jung Woo MD; Kim, Hak Jun MD, PhD
Clinical Journal of Sport Medicine ():10.1097/JSM.0000000000001178, July 18, 2023. | DOI: 10.1097/JSM.0000000000001178

Objective:
Although the incidence of contralateral Achilles tendon in patients with Achilles tendon rupture is higher than in the general population, there are no studies evaluating the status of the contralateral Achilles tendon. The aim of this study was to investigate the status of the contralateral Achilles tendon in patients with acute Achilles tendon rupture.

Design:
Prospective observational cohort study.

Setting:
University hospital foot and ankle clinic.

Participants:
Seventy-five patients with acute Achilles tendon rupture who met the inclusion criteria.

Intervention:
Ultrasonography performed by an orthopedic surgeon who had 8 years of experience in musculoskeletal ultrasonography.

Main Outcome Measures:
Ultrasonographic abnormalities of the contralateral Achilles tendon at the time of diagnosis of acute Achilles tendon rupture. Abnormalities were categorized as intratendinous lesions, peritendinous lesions, changes in retrocalcaneal bursa, and Achilles tendon thickening.

Results:
The maximal Achilles tendon thickness had a mean of 4.8 ± 1.0 mm. Nine patients (12%) showed ultrasonographic abnormalities on the contralateral Achilles tendon, and the presence of exertional pain was the sole associating variable with ultrasonographic abnormalities.

Conclusion:
The prevalence of ultrasonographic abnormalities in the contralateral Achilles tendon shown in this study was not higher than that reported in healthy or asymptomatic Achilles tendon. Therefore, routine evaluation of the contralateral Achilles tendon is unnecessary at the time of acute Achilles tendon rupture.
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NewsBot · Aug 13, 2023

A clinical comparison of two different surgical techniques in the treatment of acute Achilles tendon ruptures: Limited-open approach vs. percutaneous approach
İzzet Özay Subaşı et al
Ulus Travma Acil Cerrahi Derg. 2023 Aug;29(8):935-943. doi: 10.14744/tjtes.2023.90839.

Background: Surgical treatment is the commonly preferred method for treating acute Achilles tendon ruptures (AATRs) due to advantages such as less re-rupture rates, better functional results, and an early return to physical activities. The main aim of our study is to compare two common minimally invasive surgical methods, the limited open and the percutaneous approaches, regarding clinical outcomes.

Methods: A total of 53 patients (19 females and 34 males) who were treated with limited open (Group 1: 30 patients) and percutaneous (Group 2: 23 patients) approaches for AATRs were retrospectively evaluated between March 2019 and May 2020 in a level 1 trauma center. The evaluation included complications (soft tissue and skin problems, re-rupture, and sural nerve injury rates), the operation time, the duration of return to daily activities, The Achilles Tendon Total Rupture Score (ATRS), and the American Ortho-pedic Foot and Ankle Society (AOFAS) scores of the patients at the first and 6th months of follow-up. Patients' activity levels were compared with the Tegner Activity Scale (TAS).

Results: The mean age of all patients in this cohort was 45.1±14.1. The mean postoperative follow-up period for group 1 was 36.9±8.81 weeks, whereas, for group 2, it was 35.4±8.73 weeks (P=0.24). The mean age (P=0.47), gender distribution (P=0.41), and body mass index (P=0.29) were similar for both groups. The mean operation time (group 1: 47.1±5.4 vs. group 2: 44.4±6.1, P=0.06) and the duration of return to daily activities (group 1: 49.2±7.4 vs. group 2: 48.5±9.7, P=0.38) were also similar. There was no statistical difference between groups regarding functional results at first (ATRS: group 1: 79.9±3.2 vs. group 2: 79.5±3.9, [P=0.35], and AOFAS: group 1: 80.9±3.1 vs. group 2: 82.1±3.2, [P=0.10]) and 6th months (ATRS: group 1: 85.0±3.8 vs. group 2: 83.7±4.4, [P=0.13], and AO-FAS: group 1: 86.6±3.6 vs. group 2: 86.7±4.2, [P=0.46]). There were no statistically significant differences between groups regarding preoperative and last follow-up TAS scores (P= 0.94 and P=0.46, respectively). We observed no postoperative complications in group 1. There were three complications (13.1%) in group 2. One patient (4.4%) had a re-rupture, and two patients (8.7%) had sural nerve injuries.

Conclusion: Although both groups had similar functional results, the limited open approach yielded better clinical outcomes according to the complication results than the percutaneous approach.
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NewsBot · Aug 13, 2023

Return to Play Following Achilles Tendon Rupture in NFL Players Based on Position
Dane Barton, MD et al
Foot & Ankle Specialist

Background:
The purpose of this study was to determine the return-to-play (RTP) rate and postinjury performance after Achilles tendon (AT) ruptures in National Football League (NFL) skill position players.
Methods:
The study included NFL skill positions with an AT rupture between the 2009-2010 and 2015-2016 seasons. Performance data were collected and compared against a matched control group. RTP was defined as playing in at least 1 game after repair.
Results:
RTP rate was 57% for the study cohort. The tight ends (TEs) had the highest RTP rate at 71% while the wide receivers (WRs) had the lowest RTP rate at 38%. Compared with the control group, WRs with successful RTP had significantly less receptions per game (P = .01). For defensive players with RTP there were significant decreases in postrepair performance in tackles, passes defended, and fumbles forced/recovered compared with the control group.
Conclusion:
A total of 57% of players achieved RTP with WRs and running backs (RBs) having the lowest RTP rates and TEs and linebackers (LBs) having the highest RTP rates. RBs, defensive backs (DBs), and LBs with successful RTP had decreased performance in all categories. This updated information may be helpful for athletes, physicians, scouts, and coaches in evaluating players with a history of AT rupture.
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NewsBot · Aug 14, 2023

Bilateral Achilles Tendon Ruptures in the NFL
Aman Chopra et al
Source

Background: Achilles tendon ruptures (ATR) can have devastating results for athletes in the National Football League (NFL). While many studies have examined the effects of an ipsilateral ATR, there are no reports on the impact of bilateral ATRs on NFL athlete performance. Methods: Publicly available online injury data for NFL athletes who sustained bilateral ATRs between the start of the 2007 season and the start of the 2021 season were queried using online news and sports analysis web sources. Results: After applying inclusion and exclusion criteria, 5 NFL athletes were identified. The findings demonstrated a significant difference in age at the time of each rupture (27.8 vs 30.4 years, P < .01) along with a decreasing trend in the number of Pro Bowl nominations following successive ATRs (P = .027). There were no differences reported for the duration and number of games missed during either rehabilitation period following an ATR. Upon analyzing defensive NFL athletes, forced fumbles was the only performance metric that significantly changed across successive ATRs. Conclusion: Overall, bilateral ATRs can adversely impact an NFL player’s performance and further research should be performed to continue analyzing the effects of bilateral ATRs on these athletes.
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NewsBot · Aug 16, 2023

Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture
Kamil Kokulu et al
Source

Introduction:
Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR.
Methods:
This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager’s fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain.
Results:
Kager’s fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager’s fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings.
Conclusion:
Clinicians should be particularly aware of Kager’s fat pad sign when examining lateral ankle radiographs for ankle injury.
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NewsBot · Aug 18, 2023

No Loss of Strength after Insertional Achilles Tendon Reconstruction with Single Anchor or Double Row Repair
J. George DeVries, DPM, FACFAS et al
August 17, 2023

Many different types of surgical repair for insertional Achilles tendinosis have been described. Strength after surgery is an essential factor for patient function and satisfaction. A retrospective series of patients that underwent surgery for insertional Achilles tendon surgery were contacted to come in for prospective strength testing, with the tester blinded to the type of surgery performed. Thirty-seven patients came in for testing, 24 with a single anchor repair and 13 with a double row repair. Strength of plantarflexion was tested at 60°/sec and 120°/sec and was compared. First each operative leg was compared to the non-operative leg as a control. Then the percentage change, or symmetry, from the control leg to the operative leg was compared between those with a single anchor and double row repair. Satisfaction was also assessed with a simple questionnaire and compared the types of repair. The results demonstrated there was no statistically significant change in strength after surgery compared to the non-operative leg, and there was no difference in limb symmetry between types of repair. Similarly, there was no difference between the groups in satisfaction. Our study showed that there is, on average, no loss of strength after insertional Achilles tendon surgery at an average follow-up of nearly two years, regardless of type of repair.
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NewsBot · Aug 22, 2023

Comparison Between Percutaneous and Open Repair
in Acute Tendon Achilles Rupture in Active
Young Patients
Abd-ELHakeem Abdullah Farrag et al
International Medical Journal 4 (2023) 112e117

Background: The Achilles tendon is the strongest and most often torn tendon in the human body and it is known that
this rupture rate is rising in the third or fourth decade of life and it affects males more frequently. The majority of
ruptures happen when doing sports.
Aim: To compare between percutaneous and open repair of acute Achilles tendon rupture in active young patients who
want to go back to resume activity following the repair.
Patients and methods: 30 participants were included in this prospective comparative research and randomly assigned to
groups A and B. (each consists of 15 patients). While group A got percutaneous repair, group B had open repair.
Hospitals affiliated with Al-Azhar University were the study's site (Al-Hussien University Hospital) as well as Zagazig
General Hospital. The duration of the study was eighteen months.
Result: No statistically substantial variation was detected between the two techniques as regard functional results
(full weight-bearing, return to activity, muscle strength, and AOFAS score) at last follow-up. However, patients in the
percutaneous group were able to achieve significantly larger degrees of ankle plantar flexion compared with the open
group.
Conclusion: At the long-term checkup, there is no variation between percutaneous and open Achilles tendon repairs.
Although both groups had functionally equivalent results, open surgery of the Achilles tendon was linked with more
wound problems.
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NewsBot · Aug 31, 2023

The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear
E. Shitrit, E. Valentin, N. Baudrier, Y. Bohu, G. Rauline, R. Lopes, T. Bauer & A. Hardy
Source

Purpose
The return to sport is one of the main goals following Achilles tendon tear repair. Several psychological factors influence the return to sport after a sports injury. The traditional tools to assess the return to sport do not take into account psychological factors. The ankle ligament reconstruction-return to sport injury (ALR-RSI), validated for ankle instability, is a score to evaluate psychological readiness to return to sport. The goal of this study was to validate the ALR-RSI score for the assessment of the readiness to return to sport after Achilles tendon repair.

Methods
The ALR-RSI score, adapted from the anterior cruciate ligament-return to sport injury (ACL-RSI) score used following knee ligament reconstruction, was validated according to the international COSMIN methodology. Patients operated for Achilles tendon repair responded to the questionnaire during the rehabilitation period. The EFAS, FAAM and VISA-A scores were used as reference questionnaires.

Results
A total of 50 patients were included. The ALR-RSI score was strongly (r > 0.5) correlated to the EFAS score: r = 0.68 [0.50–0.80] the FAMM sport score: r = 0.7 [0.52–0.84] the FAAM AVQ score (r = 0.6 [0.35–0.78]), and the VISA-A score (r = 0.54 [0.26–0.76]). The discriminant validity was good with the ALR-RSI, which was significantly lower in the patients that did not return to sport: 60.7 (40–81.4) compared to those that did: 83.2 (64.3–100) p = 0.001. Reproducibility was excellent with an intra-class correlation coefficient ρ of 0.99 [097–1.00]. The internal consistency was excellent (alpha coefficient = 0.95).

Conclusion
The ALR-RSI score provides a valid, reproducible assessment of the psychological readiness to return to sport in patients who undergo surgical Achilles tendon suture repair.
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NewsBot · Sep 5, 2023

Achilles Tendon Rupture Rate – Is There a COVID-19 Pandemic Effect?
R Ismail
British Journal of Surgery, Volume 110, Issue Supplement_7, September 2023, znad258.700, https://doi.org/10.1093/bjs/znad258.700

Aim
The COVID-19 pandemic has caused a noticeable shift in trauma injuries across the United Kingdom. Achilles tendon ruptures (ATR) – a common sports-related injury – are frequently seen in athletes who are active intermittently. This retrospective study is aimed at proving the hypothesis that restriction easing and shift in activity levels during the COVID-19 pandemic has led to a higher prevalence of ATR in comparison to pre-pandemic numbers.

Method
Our study looked at ATR cases referred to the Virtual Fracture Clinic locally. We reviewed historical cases from 2015 to 2021 to compare rates and incidences of pre-pandemic cases with those during the pandemic and after restrictions were lifted. Additionally, we developed a scoring system to quantify the level of physical activity and exercise restrictions during the pandemic. The incidence and rate of ATRs were recorded and mapped against a restriction score over the course of the pandemic.

Results
Pre-pandemic, the yearly average number of ATR referrals was 77, but was 110 in 2021 after restrictions were lifted. In addition, the number of cases in 2020 during the pandemic was 63. Furthermore, when cases were mapped against activity restrictions throughout the pandemic period (2020-2021), a clear elevation in the number of cases emerges as the restrictions ease.

Conclusions
After restrictions were lifted, yearly cases were revealed to be considerably higher than the average pre-pandemic numbers. This shows that after a period of more sedentary lifestyle during the pandemic, the risk of ATR becomes higher upon return to play, hence supporting our hypothesis.
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NewsBot · Sep 6, 2023

Rates of Operative Management for Achilles Tendon Rupture Over the Last Decade and the Influence of Gender and Age
J. Heath Wilder, MD et al
Source

Background
With emerging evidence supporting functional rehabilitation for Achilles tendon ruptures (ATRs), this study sought to evaluate the treatment trends for patients sustaining an acute ATR and whether gender and age may influence the rates of operative repair.
Methods
A retrospective database review identified ATRs from 2010 through 2019. Patients were then stratified into three cohorts based on age (18-30, 30-45, and 46 and older), separated by gender, and then assessed whether patients were treated operatively or not. Cochran-Armitage Trend test was performed to analyze the trends of operative management. Chi-square analyses were performed to assess whether the proportion of patients who received operative management in each age cohort differed from 2010 to 2019. Logistic regression analyses were performed to assess whether gender influenced treatment.
Results
Over the previous decade, the total rates of operative treatment for ATR significantly decreased (18.3%-12.3%, P < .0001). Each individual age cohort experienced a proportional decrease in operative management when comparing 2010 with 2019 (all P < .0001). Within all age cohorts, males were significantly more likely to receive operative treatment for an ATR over the previous decade (odds ratios: 2.63-3.22). Conclusion. Overall rates of operative management for ATR decreased across all cohorts likely due to previous studies providing evidence of similar results between operative and nonoperative managements. Over the previous decade, males were demonstrated to be far more likely than females to undergo operative management. Why females are less likely to receive an operation for ATR is likely multi-factorial and requires further exploration.
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NewsBot · Sep 6, 2023

Mini-Open Achilles Tendon Repair: Improving Outcomes While Decreasing Complications
Tyler Hoskins et al
Source

An acute rupture of the Achilles tendon is a traumatic injury that can cause considerable morbidity and reduced function. Nonoperative intervention may put patients at higher risk of rerupture, whereas surgical intervention carries risk of infection, wound complications, and iatrogenic nerve injury. The mini-open Achilles tendon repair technique has been popularized in helping decrease complications. The goal of this study was to examine and compare the functional outcomes and rate of complications in patients treated with a mini-open repair technique versus a traditional open repair for acute Achilles tendon ruptures. A retrospective review was performed of all patients with a complete Achilles tendon rupture that were treated by a single foot and ankle fellowship-trained surgeon. Functional outcome scores were assessed using the American Orthopaedic Foot and Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Eighty-one patients with a complete Achilles tendon rupture underwent mini-open repair and 22 patients underwent traditional open repair surgery between 2013 and 2020. The mean follow-up was 38.40 months (range, 12-71). Mean preoperative AOFAS and ATRS improved in the mini-open group from 45.60 and 47.18 respectively, to 90.29 and 87.97 after surgery (p < .05). Mean preoperative AOFAS and ATRS scores for the traditional open repair (n = 22) cohort were 44.02 and 42.27, respectively. Postoperatively, the AOFAS and ATRS scores improved to 85.27 and 86.64 (P value < .05), respectively. There was no statistically significant difference in postoperative ATRS scores. However, the mini-open repair group showed a statistically higher postoperative AOFAS score (90.30) than the traditional open-repair group (85.27) (P value < .05). The overall complication rate for our study was 2.9% (2 mini-open repair and 1 traditional open repair). The complication rate in the mini-open repair group and traditional open repair cohort were 2.4% and 4.5%, respectively (P value > .05). One patient in the mini-open repair cohort (1.2%) reruptured his Achilles tendon 4 months postoperatively. A second patient in the mini-open repair group (1.2%) developed a superficial skin infection and suture irritation. One patient (4.5%) in the traditional open repair group developed a superficial skin infection. There were no sural nerve injuries in our series. The mini-open approach to repair a ruptured Achilles tendon is a viable treatment option to decrease the incidence rate of postoperative complications and rerupture rates while also producing a superior cosmetic result.
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NewsBot · Sep 6, 2023

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study
LT Thomas J. Kelsey et al
Source

Background
In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair’s maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy.
Methods
Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure.
Results
The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure (P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed).
Conclusion
This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.
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NewsBot · Sep 17, 2023

Surgical treatment of chronic achilles tendon rupture: An anatomical consideration of various autograft options
Vidhi Adukia et al
Journal of Orthopaedics; 12 September 2023

Background
Acute Achilles tendon rupture is a common injury and when missed leads to the development of a chronic Achilles tendon rupture. Studies suggest surgical treatment (either repair or reconstruction) for most patients with a chronic Achilles rupture due to the functional deficit caused by the lack of an intact Achilles tendon. Numerous autograft options such as the flexor hallucis longus, hamstrings, peroneal and quadriceps tendon have been used to reconstruct the Achilles tendon, either as a tendon transfer or as an interposition graft. The choice of autograft used usually depends on the size of the defect left after debridement of the Achilles tendon edges, but is often dictated by surgeon preference and tissue availability. Currently, there is no consensus as to the best autograft option.

Aims and methodology
The aim of this study was to evaluate the various autograft options used to reconstruct the Achilles tendon, and the advantages and disadvantages of using each tendon, focussing specifically on the harvesting technique, anatomical and biomechanical properties. This was done by reviewing the current published literature, supplemented by carrying out anatomical dissection in the cadaveric lab.

Results
The flexor hallucis longus works is synergistically related to the Achilles tendon and biomechanically strong, however harvesting can result in weakness in big toe flexion. The peroneus brevis whilst being biomechanically strong is a much shorter tendon compared to the other autograft options. Similarly, the quadriceps tendon is also a strong tendon option, but may not be appropriate for larger chronic Achilles tendon rupture gaps. The semitendinosus tendon can be tripled/quadrupled to resemble the Achilles tendon, but is associated with higher risks of patient morbidity when harvesting the tendon.

Conclusion
Treatment of chronic Achilles tendon ruptures remains a challenge. Each autograft option has its own unique advantages and disadvantages which should be considered on a case-specific basis. Further work is required to analyse the biomechanical properties of the autograft options to determine if one option is superior.
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NewsBot · Sep 19, 2023

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture
Shengzhu Lu et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Sep 15;37(9):1062-1067.

Objective: To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.

Methods: A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.

Results: The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).

Conclusion: In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
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NewsBot · Sep 21, 2023

Methods of Immobilization after Achilles Tendon
Rupture Repair: A Comparative Study in Rat Model
Tianliang Wang, MD et al
ORTHOPAEDIC SURGERY VOLUME 9999 • NUMBER 9999 • 2023

Objective: The Achilles tendon (AT) is the most frequently ruptured in the human body. Literature describing different
immobilization methods’ impact on tendon healing after AT repair is lacking. We compare plaster cast, splint, and
K-wire to determine which is the most stable and has the fewest complications.
Methods: Sixty rats aged 5–6 months were selected to establish Achilles tendon injury in two hind legs model.
After suturing the ends of the AT together with a modified “Kessler” method (Prolene 5–0). The skin incision was
interrupted and sutured with 1–0 thread. Rats were divided into three immobilization methods (plaster cast group,
splint group, and K-wire group). In plaster cast group, the hind leg was cast with plaster in the extended position
of the hip and knee joints, and the ankle joint was at 150. Splint and K-wire group used splints and 0.8-mm
K-wires, separately. The fixed period was 4 weeks. The incidence of stability and complications (death, necrosis
of the legs, necrosis of the skin, and incisional infection) were recorded. Differences were detected using the chisquare test.
Results: Within 4 weeks observation, K-wires showed better stability (90%) compared with the other two ways (40% in
plaster cast group, 65% in splint group; p < 0.05). Rats immobilized with K-wires (10%) suffered significantly lower
complications compared with plaster cast and splint group (15%; p < 0.05).
Conclusion: K-wire has better stability, lower complication rate than other methods. Immobilization with K-wire may
be a promising tool in future clinical Achilles tendon rupture applications.
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NewsBot · Sep 25, 2023

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture
Lu S et al
Chinese Journal of Reparative and Reconstructive Surgery, 01 Sep 2023, 37(9):1062-1067

Objective
To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.
Methods
A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.
Results
The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).
Conclusion
In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
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NewsBot · Sep 27, 2023 at 10:12 AM

Methods of Immobilization after Achilles Tendon Rupture Repair: A Comparative Study in Rat Model
Tianliang Wang et al
Orthop Surg. 2023 Sep 15

Objective: The Achilles tendon (AT) is the most frequently ruptured in the human body. Literature describing different immobilization methods' impact on tendon healing after AT repair is lacking. We compare plaster cast, splint, and K-wire to determine which is the most stable and has the fewest complications.

Methods: Sixty rats aged 5-6 months were selected to establish Achilles tendon injury in two hind legs model. After suturing the ends of the AT together with a modified "Kessler" method (Prolene 5-0). The skin incision was interrupted and sutured with 1-0 thread. Rats were divided into three immobilization methods (plaster cast group, splint group, and K-wire group). In plaster cast group, the hind leg was cast with plaster in the extended position of the hip and knee joints, and the ankle joint was at 150°. Splint and K-wire group used splints and 0.8-mm K-wires, separately. The fixed period was 4 weeks. The incidence of stability and complications (death, necrosis of the legs, necrosis of the skin, and incisional infection) were recorded. Differences were detected using the chi-square test.

Results: Within 4 weeks observation, K-wires showed better stability (90%) compared with the other two ways (40% in plaster cast group, 65% in splint group; p < 0.05). Rats immobilized with K-wires (10%) suffered significantly lower complications compared with plaster cast and splint group (15%; p < 0.05).

Conclusion: K-wire has better stability, lower complication rate than other methods. Immobilization with K-wire may be a promising tool in future clinical Achilles tendon rupture applications.
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NewsBot · Oct 2, 2023 at 1:03 AM

The effect of smoking on 30-day complications following primary repair of Achilles tendon ruptures
Anna M. Ifarraguerri, Theodore Quan, Benjamin Farley, Emile-Victor Kuyl, John Koch, Philip M. Parel, Alisa Malyavko & Sean Tabaie
European Journal of Orthopaedic Surgery & Traumatology (2023)

Purpose
There exists a gap in the knowledge of the impact of smoking on Achilles tendon rupture repair. This study evaluates perioperative and postoperative complications associated with smoking to allow for a more informed evaluation and discussion with the patients when considering the surgical management of Achilles tendon repair in this patient population.

Methods
The National Surgical Quality Improvement Program database was queried for patients undergoing Achilles tendon rupture repair from 2006 to 2019. Two patient cohorts were defined in this retrospective study: smokers and patients who did not smoke. The various patient demographics, medical comorbidities, and postoperative outcomes were compared using bivariate and multivariate analyses between the smoking and non-smoking groups.

Results
Of 4209 patients who underwent Achilles tendon repair, 3662 patients (87%) did not smoke, whereas 547 patients (13%) were smokers. Patients who were smokers were more likely to be younger and have a higher body mass index. Following multivariate analyses, those who smoked had an increased risk of experiencing wound dehiscence (OR 3.57; p = 0.013) and urinary tract infections (OR 1.21; p = 0.033) compared to non-smoking patients.

Conclusion
Despite the rate of complications being relatively low in the short-term perioperative period, individuals who smoke should be counseled on the surgical risks they may experience following Achilles tendon repair, including wound dehiscence and urinary tract infections. Discussion preoperatively between the physician and patient who smoke can include ways in which postoperative care will be done to minimize the risk of adverse events, ultimately reducing costs for both the patient and the hospital.
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NewsBot · Oct 2, 2023 at 1:03 AM

Is a Preoperative MRI Scan Necessary for Acute Achilles Tendon Rupture?
Xiang Geng et al
Orthop Surg. 2023 Sep 25

Background: Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and open surgery, and there is no consensus about which method is superior. It is important to clarify the presence of Achilles tendon (AT) degeneration, the rupture site, and the rupture shape before surgery to determine whether minimally invasive or open surgery should be selected, thereby reducing the re-rupture rate following acute ATR. The aim of this study was to investigate the diagnostic value of MRI in identifying the presence of AT degeneration, the rupture site, and the rupture shape for acute closed ATR.

Methods: From January 2016 to December 2019, patients with acute closed ATR who had undergone repair surgery were retrospectively enrolled. All patients received MRI examination, and the distance between the insertion site and broken end and the rupture shape (types I, II, and III) were independently determined by two observers. Then, the stump of the AT was exposed during the operation. The rupture site and rupture shape were recorded and compared and analyzed with the MRI results. Consistency analyses (using Cohen's kappa coefficient or intraclass correlation coefficient-ICC) and calculation of diagnostic performance indexes were, respectively, conducted to evaluate the diagnostic value of the MRI.

Results: This study included 47 consecutive patients with acute ATR, with an average age of 38.4 years. Among them, 40 were male, and seven were female. The intraoperative exploration demonstrated a total of 34 (72.3%), 10 (21.3%), and three (6.4%) patients with type I, II, and III ruptures, respectively. The average distance between the insertion site and the proximal broken end measured intraoperatively was 4.07 ± 1.57 cm. High or excellent consistencies were found for ATR classifications (kappa: 0.739-0.770, p < 0.001) and rupture sites (ICC: 0.962-0.979, p < 0.001) between two observers and between observers 1 and 2 and intraoperative findings. Tendinopathy was identified in 22 patients by MRI and confirmed during surgery.

Conclusions: MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.
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Achilles tendon rupture

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Depression folowing surgery for an achilles tendon rupture

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Achilles Tendon Thickness Depends on the Number of Meals Per Day !

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Achilles tendon rupture

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Depression folowing surgery for an achilles tendon rupture

Are bacteria involved in achilles tendon ruptures?

Past ruptured achilles tendon

Achilles Tendon rupture and Plantar Fasciitis

Achilles Tendon and Femoral Cartilage Thickness in Flatfoot

Tendon structure and Achilles tendinopathy symptoms

Achilles Tendon Thickness Depends on the Number of Meals Per Day !

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