Achilles tendon rupture

NewsBot · Jun 4, 2024

Auditing the Representation of Female Athletes in Sports Medicine Research: Achilles Repair
Michael Braman et al
Foot Ankle Orthop. 2024 May 31;9(2)

Background: Establishing evidence-based recommendations specific to female athletes has been overlooked in sports medicine. Achilles tendon rupture is one of the most common musculoskeletal injuries, occurring in 15 to 55 per 100 000 people annually. Differences in injury rates could be due to hormonal effects, as estrogen receptors have been identified in tendons along with decreased tendon strain based on oral contraceptive use. The primary purpose of this study was to audit the representation of female athletes in the literature regarding Achilles repair.

Methods: An electronic search was performed using PubMed to identify articles related to Achilles repair using the protocol by Smith et al. Studies were assessed by population, size, athletic caliber, study impact, research theme, and menstrual status.

Results: Female representation across all studies was 1783 of 10 673 subjects (16.7%). Composition of included studies was predominantly mixed-sex cohorts with 131 of 169 (77.5%) included studies. Within mixed-sex cohort studies, the total representation of female athletes was 1654 of 8792 participants (18.9%). Thirty-two studies were male only, constituting 1540 participants, whereas 3 studies were female only composed of 86 athletes. Importantly, the disparity between male and female representation worsened as the athletic caliber of the study population increased, with 5.0% female representation in studies with professional athletes. No study collected data related to menstrual status and its potential relationship to Achilles rupture or postoperative outcomes.

Conclusion: Mixed-sex cohort studies underrepresented female athletes, and male-only cohort studies were more common than female-only studies. These findings indicate a need for increased representation of female athletes as well as acknowledgment of menstrual status in research related to Achilles repair. Future studies should focus on representation of female athletes and data collection related to sex-specific hormones, hormonal contraceptive use, and menstrual status to improve treatment of Achilles tendon ruptures for female athletes.
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NewsBot · Jun 5, 2024

Functional Performance and Tendon Morphology After Operative or Nonoperative Treatment of Achilles Tendon Ruptures
Sophie Zhu, M.D., Josh Garofalo, Monther Abuhantash, M.D., Sheila McRae, Ph.D, Peter MacDonald, M.D., Rob Longstaffe, M.D., Dan Ogborn, MSc PhD
IJSPT. 2024;19(6):670-680. doi:10.26603/001c.117549

Background
While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon (AT) ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping.

Hypothesis/Purpose
The purpose of this study was to determine if functional performance including strength, jumping, and hopping outcomes differed between OM and NOM of acute ATR. The secondary objective was to assess the degree of association between AT morphology and performance outcomes.

Study Design
Retrospective cohort with a single prospective evaluation.

Methods
All patients were treated at an institutional secondary care center. Eligible participants (n=12 OM; 12 NOM) who were treated with OM or NOM of ATR within three weeks of injury were evaluated a minimum 20 months following ATR. AT length, thickness and gastrocnemius muscle thickness were assessed with B-mode ultrasound. Isokinetic plantar flexor strength, hop tests and countermovement and drop jumps were completed. Two-way ANOVAS were completed on all tests with unilateral values, independent t-tests were used for bilateral outcomes, and linear regressions were completed to assess the relationship between normalized AT length and performance.

Results
Affected limb AT was elongated and thickened (p<0.01), gastrocnemius was atrophied (p< 0.01) and angle-specific plantar flexor torque was reduced at 120°/s when measured at 20° plantar flexion (p = 0.028). Single leg drop vertical jump was higher in OM (p = 0.015) with no difference for hop and jump tests. AT length was related to plantar flexor torque but had no relationship with hopping performance.

Conclusions
Hop test performance was maintained despite plantarflexion weakness, gastrocnemius atrophy, and AT elongation. This may be the result of compensatory movement patterns. AT length holds limited explanatory power in plantar flexor strength, although this relationship should be evaluated further.
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NewsBot · Jun 13, 2024

Treatment of Achilles tendon rupture in a patient with alkaptonuric ochronosis
Kryukov E.V. et al
BULLETIN OF THE RUSSIAN MILITARY MEDICAL ACADEMY

The treatment result of a patient with spontaneous rupture of the Achilles tendon and features of diagnosing alkaptonuric ochronosis, a rare disease, are presented, providing doctors beneficial information for the prevention and/or delay of possible complications. On March 8, 2021, at about 20:50, while at his workplace, getting up from his chair from the table, patient K, 52 years old, felt a sharp pain in the lower third of his right shin and was urgently taken to the hospital. He was examined by a traumatologist and was initially diagnosed with rupture of the right Achilles tendon. His right lower limb was immobilized with a plaster splint. On March 11, 2021, he entered the military traumatology and orthopedics clinic of the Kirov Military Medical Academy for surgical treatment. Upon admission, the patient complained of pain in the right lower leg and impaired support function of the right lower limb. Based on complaints, medical history, laboratory results, and instrumental studies, subcutaneous rupture of the right Achilles tendon was diagnosed. On March 12, 2021, anchor suture of the right Achilles tendon was performed. Anesthesia — combined, access: two separate incisions on the posterior surface of the lower third of the right leg and in the area of the calcaneal tubercle, each 5 cm long, intraoperatively revealed a complete subcutaneous rupture of the right Achilles tendon. Notably, the tendon was black in color when cut. The postoperative period proceeded without complications, and postoperative wounds of linear shape in the right Achilles tendon healed by primary intention. No signs of disturbances were observed in peripheral circulation and innervation of the right lower limb. To confirm the diagnosis, a simple laboratory test was performed: a change in the color of urine during the day, after its additional alkalization. The color change is due to the polymerization of homogentisic acid, which is excreted in large quantities in the urine. To verify the diagnosis, a molecular genetic technique was performed: sequencing of the clinically significant HGD gene and encoding the enzyme homogentisate-1,2-dioxygenase, which are mutations that lead to alkaptonuria. The analysis results confirmed the presence of an amino acid substitution at the pGLy161Arg position, indicating pathogenicity. The use of simple methods of additional laboratory diagnostics and molecular genetic analysis enabled the diagnosis of alkaptonuric ochronosis. Thus, characteristic diagnostic signs were damage to the Achilles tendon in combination with the obtained anamnestic, clinical, and laboratory data of alkaptonuria.
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NewsBot · Jun 13, 2024

"Economic and Performance Analysis of Achilles Tendon Rupture in the National Basketball Association,"
Qiu, Abram; Meadows, Kristopher; Iyawe, Osasu; Ye, Fei; and Kenneth-Nwosa, Kenneth (2024)
International Journal of Exercise Science: Conference Proceedings: Vol. 2: Iss. 16, Article 31.

Achilles tendon ruptures are common and potentially career-ending injuries for National Basketball Association (NBA) players. Many studies review the impact of Achilles tendon ruptures on return to play (RTP) and performance, but there are no studies on their economic significance. PURPOSE: This study aimed to analyze the economic and performance consequences of Achilles tendon ruptures. The financial burden for NBA teams was represented by the cost of recovery (COR) as well as preinjury salary and career success. We hypothesized that players with higher pre-injury salaries or performance would have an increased cost of recovery, higher rates of RTP, and more career success following their injury. METHODS: We analyzed publicly available data of NBA players who suffered an Achilles tendon rupture from 1990 to 2023. Data were retrospectively gathered by R software code to include players’ ages, positions, salaries, pre- and post-injury PER, time missed following injury, and RTP. Performance impact was measured by advanced statistics: player efficiency rating (PER), Win Shares per 48 Minutes (WS/48), and Value Over Replacement Player (VORP). Two groups of three cohorts were created: All-Star, Starter, and Reserve versus Group A ($8,999,999). RESULTS: 37 players met the inclusion criteria. The mean COR that NBA teams faced was $4,054,443 per player. The cumulative economic loss from Achilles tendon ruptures in the NBA from 1992-2019 was $117,578,851. Overall RTP was 78.38%, and 48.88% of players were out of the NBA in 3 years. RTP to the highest playing level was highest in Group B (45.5%), followed by Group A (40%), then Group C (12.5%). The COR of All-Stars, Starters, and Reserves averaged $5.7 million, $3.4 million, and $3 million, respectively. CONCLUSION: This study investigated the financial and performance implications of Achilles tendon ruptures among NBA athletes. Most players struggled to restore their pre-injury performance, except for Reserve players who maintained their prior levels. Our findings provide valuable insights into the complexities of Cost of Recovery and post-injury performance.
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NewsBot · Jun 13, 2024

Comparison of rerupture rates after operative and nonoperative management of Achilles tendon rupture in older populations: Systematic review and meta-analysis
Daniel Acevedo et al
Journal of Orthopaedics; Volume 52, June 2024, Pages 112-118

Background
This systematic review and meta-analysis investigated the treatment for Achilles tendon rupture (ATR) associated with the lowest risk of rerupture in older patients.

Methods
Five databases were searched through September 2022 for studies published in the past 10 years analyzing operative and nonoperative ATR treatment. Studies were categorized as “nonelderly” if they reported only on patients aged 18–60 years. Studies that included at least 1 patient older than age 70 were categorized as “elderly inclusive.” Of 212 studies identified, 28 were eligible for inclusion. Of 2965 patients, 1165 were treated operatively: 429 (37%) from elderly-inclusive studies and 736 (63%) from nonelderly studies. Of the 1800 nonoperative patients 553 (31%) were from nonelderly studies and 1247 (69%) were from elderly-inclusive studies.

Results
For nonoperative treatment, the rate of rerupture was higher in nonelderly studies (83/1000 cases, 95% CI = 58, 113) than in elderly-inclusive studies (38/1000 cases, 95% CI = 22, 58; P<.001). For operative treatment no difference was found in the rate of rerupture between nonelderly studies (7/1000 cases, 95% CI = 0, 21) and elderly-inclusive studies (12/1000 cases, 95% CI = 0, 35; P<.78). Overall, operative treatment was associated with a rerupture rate of 1.5% (95% CI: 1.0%, 2.8%) (P<.001), which was lower than the 5% rate reported by other studies for nonoperative management (P<.001).

Conclusion
Older patients may benefit more than younger patients from nonoperative treatment of ATR. More studies are needed to determine the age at which rerupture rates decrease among nonoperatively treated patients.
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NewsBot · Jun 14, 2024

PLATELET-RICH PLASMA FOR ACUTE ACHILLES TENDON RUPTURE. TWO-YEAR FOLLOW-UP OF THE RANDOMIZED, PLACEBO-CONTROLLED, SUPERIORITY TRIAL
J. Alsousou et al
The British Orthopaedic Foot & Ankle Society (BOFAS) Annual Congress 2023, Liverpool, England, 8–10 March 2023.

Background
The PATH-2 trial found no evidence of a benefit of Platelet Rich Plasma (PRP) injection versus a placebo after Achilles tendon rupture (ATR) at six-months. ATR often leave longer-term functional deficiencies beyond six-months. This study aim is to determine if PRP affect tendon functional outcomes at two-years after rupture.

Study design
Randomised multi-centre two-arm parallel-group, participant- and assessor-blinded, superiority trial.

Methods
Adults with acute ATR managed non-surgically were recruited in 19 UK hospitals from 2015 to 2019. Exclusions were insertion or musculotendinous injuries, leg injury or deformity, diabetes, haematological disorder, corticosteroids and anticoagulation therapy. Participants were randomised via an online system 1:1 to PRP or placebo. Primary outcome was Achilles Tendon Rupture Score (ATRS) at two-years. Secondary outcomes were pain, Patient-Specific Functional Scale (PSFS), SF-12 and re-rupture. Assessors were blinded. Intention-to-treat and Compliance Average Causal effects (CACE) analyses were carried out. Consistency of effects across subgroups age, BMI, smoking and gender were assessed using Forest plots. Pearson's correlation was used to explore ATRS correlation with blood and growth factors.

Results
216/230 (94%) participants completed the 6-months follow-up were contacted. 182/216 (84%) completed the two-year follow-up. Participants were aged mean 46 (SD 13.0), 57 female/159 male. 96% received the allocated intervention. Two-years ATRS scores were 82.2 (SD 18.3) in the PRP group (n=85) and 83.8 (SD 16.0) in the placebo group (n=92). There was no evidence of a difference in the two-years ATRS (adjusted-mean difference −0.752 95%CI −5.523 to 4.020, p=0.757), or in any secondary outcome, and no re-rupture between at two-years. Neither PRP cellular or growth factors correlated with the two-year ATRS.

Conclusion
PRP did not improve patient-reported function or quality of life two-years after acute Achilles tendon rupture, compared with placebo, indicating that PRP offers no patient benefit in the longer term.
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NewsBot · Jun 14, 2024

INCIDENCE, DEMOGRAPHICS, CHARACTERISTICS, AND MANAGEMENT OF ACUTE ACHILLES TENDON RUPTURE
S. Briggs-Price et al
The British Orthopaedic Foot & Ankle Society (BOFAS) Annual Congress 2023, Liverpool, England, 8–10 March 2023.

Introduction
Achilles tendon rupture (ATR) account for 10.7% of all tendon and ligament injuries and causes lasting muscular deficits and have a profound impact on patients’ quality of life1,2. The incidence, characteristics and management of ATR in the United Kingdom is poorly understood.

Method
Data was collected prospectively from University Hospitals of Leicester Emergency Department (ED) between January 2016 and December 2020 and analysed retrospectively. The medical records were reviewed to determine management protocols (surgical/non-surgical) and limited mobilisation (VACOped™ boot) duration. Leicestershire population data was taken from Leicestershire County Council demography report.

Findings
277 individuals were diagnosed with an ATR during the 4-year period. The mean (SD) annual incidence was 56 (±6) ATR. An incidence rate of 8.02 per 100,000 people per annum. The average characteristics of those experiencing an ATR is male (78.3%), 46.8yrs old (±14.4), body mass index 29.1 (±6.3). Median (IQR) number of comorbidities 1 (2) and duration to present to ED was 0 days (1). The main mechanism of rupture was sporting activity (62.1%).

97.4% were non-surgically managed using a limited mobilisation boot (VACOped). The boot was worn for an average of 62.6 days (±8.9). 94 participants provided pre-ATR Achilles symptoms data. 16% (n=15/94) of participants reported a previous contralateral ATR. 7.4% reported a re-rupture (n=7/94). 15.4% (n=14/91) reported an Achilles tendinopathy on the ipsilateral side prior to ATR. 7.7% (n=7/91) reported bilateral Achilles tendinopathy and 1.1% (n=1/91) reported contralateral Achilles tendinopathy prior to ATR.

Conclusion
The incidence of ATR is 8.02 cases per 100,000 people per annum. This is the first UK data on ATR incidence. Most ATR were managed non-surgically in this cohort. The majority of ruptures occurred during sporting activity. Those that had previous Achilles symptoms (24.2%) indicate tendons are not always asymptomatic prior to ATR.
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NewsBot · Jun 25, 2024

A comparative biomechanical study of the krackow suture technique with three common percutaneous suture techniques in the treatment of Achilles tendon ruptures
Hakan Zeybek et al
Foot and Ankle Surgery Volume 30, Issue 5, July 2024, Pages 366-370

Background
The aim of this study was to compare the biomechanical resistance under tensile forces of the Krackow suture technique with the frequently used Dresden, Carmont & Maffulli, and Ma & Griffiths percutaneous repair techniques in bovine models of Achilles tendon rupture.

Methods
Transverse Achilles tendon rupture models were created from 4 cm proximal of the calcaneal insertion point in a total of 20 bovine Achilles tendon specimens. These were randomly allocated to 4 groups and repaired with configurations appropriate to the Dresden, Carmont & Maffulli, Ma & Griffiths and Krackow techniques. Failure mechanisms were recorded with force values (as Newton units) creating a 5 mm gap and load to failure under tensile loading at a rate of 10 mm/sec in a static testing device.

Results
In the Dresden technique group, the force required for a 5 mm gap was mean 41.21 ± 13.19 N and for load to failure, mean 193.83 ± 30.16 N, which were evaluated as statistically significantly higher than in the other techniques (p < 0.05). The lowest values were determined in the Ma & Griffiths technique group (5 mm gap: 11.06 ± 8.12 N, load to failure: 97.73 ± 29.60 N) but these were not significantly lower than the values in the Krackow and Carmont & Maffulli technique groups (p > 0.05).

Conclusion
The results of this study showed that the Dresden technique was biomechanically superior against tensile forces compared to the Krackow technique, and the other frequently used percutaneous techniques of Carmont & Maffulli and Ma & Griffiths.
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NewsBot · Jul 7, 2024

The effect of L-Arginine therapy on achilles tendon healing: A histological and biomechanical investigation in an animal model
Mahmut Ozdemir et al
Foot and Ankle Surgery; 15 June 2024

Purpose
Several clinical and experimental studies have revealed that L-Arginine, which has antioxidant properties, accelerates tissue healing. This study examined the in vivo effects of oral L - Arginine supplementation on tendon regeneration in Wistar rats.

Method
For each weighting of an average of 250–300 g, 24 Wistar rats were separated into three equal groups. Each rat's right hind leg Achilles tendons were tenotomized and then repaired. The first group (Control) was followed up with a regimen of standard food and water. In the second group (L-Arg Low Dose), 300 mg/kg, and in the third group (L-Arg High Dose), 600 mg/kg L-Arginine was administered in water daily with a regimen of standard food and water ad libitum. After eight weeks, the rats were sacrificed, and the tendons were histologically and biomechanically analyzed.

Results
Tendon peak strength values of the L-Arg Low Dose and L-Arg High Dose groups were similar but significantly higher than the control group. A statistically significant difference was observed between the groups in terms of ground substance, fiber arrangement, cellularity, hyalinization, and GAG properties ( p = 0.05, p = 0.002, p = 0.016, p = 0.027, p = 0.05). There was no statistically significant difference between the groups according to the histological examination of collagen properties, fiber structure, tenocyte properties, rounding of the nuclei, and collagen stainability. (p = 0.999, p = 0.061, p = 0.195, p = 0.195, p = 0.130). No mortality, wound complications, or re-ruptures were observed.

Conclusion
Compared with the control group, histologically and biomechanically distinct therapeutic effects of L-Arginine supplementation on tendon healing were determined.
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NewsBot · Jul 15, 2024

Bilateral Spontaneous Rupture of the Achilles Tendon as an Initial Presentation of Alkaptonuria: A Case Report.
PERUMAL, SUNDARA RAJA; MALATHY, K.; ANAND, C. D.
Source

Rupture of the Achilles tendon is a common occurrence in the athletic population with a history of injury; however, a complete rupture of both Achilles tendons is uncommon. Spontaneous rupture of the bilateral Achilles tendons is an even rarer phenomenon, usually highlighting an underlying pathological condition. The authors present a 32-year-old healthy male patient with no previous known comorbidities and radiological evidence of a complete tear of both Achilles tendons. Histopathological examination of resected tendon tissue revealed dark-coloured deposits within, and further investigations established the diagnosis of alkaptonuria. Non traumatic bilateral rupture of the Achilles tendon should raise suspicion of underlying metabolic/genetic disorders like alkaptonuria.
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NewsBot · Jul 16, 2024

Hyperuricemia May Increase Risk of Achilles Tendon Rupture: A Case Control Study
Yi Jiang et al
July 05, 2024

It has been demonstrated in a number of studies that high levels of uric acid can cause crystal deposition in the tendons of the lower extremities, which in turn can impair the Achilles tendon. This study aimed to interpret whether hyperuricemia is relevant with Achilles tendon rupture. Patients diagnosed with Achilles tendon rupture at the same institution between 2013 and 2022 were included in the case group. Healthy subjects who had physical examinations during the same period were included in the control group. Propensity score matching was used to match in a 1:1 ratio. Demographic and clinical characteristics of patients in both groups were compared. Five hundred and fourteen patients were included in the study (ATR=257; Control group=257). The proportion of individuals with hyperuricemia varied significantly between the two groups (Achilles tendon rupture group=43.6%; control group=27.6%; p<0.001). The Achilles tendon rupture and hyperuricemia were linked by conditional logistic regression (p<0.001; OR=2.036; 95CI%=1.400-2.961). Compared with healthy subjects, patients with hyperuricemia have a higher risk of Achilles tendon rupture. Further studies are required to verify the effects of hyperuricemia and monosodium urate crystals on Achilles tendon structure.
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NewsBot · Jul 20, 2024

Early Predictors of Recovery From Nonoperatively Treated Achilles Tendon Rupture: 1 Year Follow-Up Study
Maria Sukanen, Ra’ad M. Khair, Aleksi Reito, Ville Ponkilainen, Juha Paloneva, Neil Cronin, Arto J. Hautala, Taija Finni
15 July 2024

Purpose
To investigate early structural and mechanical predictors of plantarflexor muscle strength and the magnitude of Achilles tendon (AT) nonuniform displacement at 6 and 12 months after AT rupture.

Methods
Thirty-five participants (28 males and 7 females; mean ± SD age 41.7 ± 11.1 years) were assessed for isometric plantarflexion maximal voluntary contraction (MVC) and AT nonuniformity at 6 and 12 months after rupture. Structural and mechanical AT and plantarflexor muscle properties were measured at 2 months. Limb asymmetry index (LSI) was calculated for all variables. Multiple linear regression was used with the 6 and 12 month MVC LSI and 12 month AT nonuniformity LSI as dependent variables and AT and plantarflexor muscle properties at 2 months as independent variables. The level of pre- and post-injury sports participation was inquired using Tegner score at 2 and 12 months (scale 0–10, 10 = best possible score). Subjective perception of recovery was assessed with Achilles tendon total rupture score (ATRS) at 12 months (scale 0–100, 100=best possible score).

Results
Achilles tendon resting angle (ATRA) symmetry at 2 months predicted MVC symmetry at 6 and 12 months after rupture (β = 2.530, 95% CI 1.041–4.018, adjusted R2 = 0.416, p = 0.002; β = 1.659, 95% CI 0.330–2.988, adjusted R2 = 0.418, p = 0.016, respectively). At 12 months, participants had recovered their pre-injury level of sports participation (Tegner 6 ± 2 points). The median (IQR) ATRS score was 92 (7) points at 12 months.

Conclusion
Greater asymmetry of ATRA in the early recovery phase may be a predictor of plantarflexor muscle strength deficits up to 1 year after rupture.
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NewsBot · Jul 24, 2024

Avulsive Achilles Tendon Rupture in a Patient With Alkaptonuria: A Case Report
Luís Fabião et al
Cureus. 2024 Jun 18;16(6):e62631

Alkaptonuria is a rare autosomal recessive disease caused by a mutation in the homogentisate 1,2-dioxygenase (HGO) gene, leading to the accumulation of homogentisic acid (HGA). HGA polymerizes to form a black pigment that accumulates in connective tissue and joints (ochronosis), causing their destruction. In this work, we report a case of Achilles tendon rupture in a patient with a prior diagnosis of alkaptonuria. A 71-year-old man presented to the emergency department reporting pain in his posterior right ankle and dysfunction, evolving over three weeks after falling down a short flight of stairs. He had previously been diagnosed with alkaptonuria and had undergone five joint prostheses and an aortic valve replacement. A physical examination revealed right ankle edema, pain upon palpation, a palpable gap at the insertion of the tendon, and a positive Thompson test. An MRI confirmed an avulsive rupture at the insertion of the Achilles tendon. During surgical exploration, black pigmentation was observed in the tendon, which was reinserted using a double-row system reinforced with a percutaneous Bunnel stitch. The patient was discharged the following day with a cast splint, maintaining the foot in physiological plantar flexion for two weeks. In the subsequent two weeks, he used a non-weight-bearing walker boot, and finally, in the following two weeks, he began weight-bearing. Two months post-operation, he was walking without support. Twelve months after the intervention, the patient regained their previous functional status, being able to walk on tiptoes without difficulty. Spontaneous Achilles tendon rupture without associated trauma in patients with ochronosis is rare, with limited literature demonstrating successful outcomes post-surgery. Since the tendon becomes more fragile due to pigment accumulation, it was reinserted using a double-row system, increasing the contact area and more effectively distributing the load. There is no standard technique for treating these patients, but the patient's previous functional capacity was restored, with no new ruptures to date. The significant morbidity of alkaptonuria and potential complications, such as tendon ruptures, warrant future studies to discover and develop new prophylactic and therapeutic treatments.
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NewsBot · Jul 28, 2024

The Injury Mechanism of Achilles Tendon Rupture in Professional Athletes: A Video Analysis Study
Ali Yüce, Mustafa Yerli, Abdulhamit Misir
J Am Podiatr Med Assoc. 2024 May-Jun;114(3):21-196

Background: In professional athletes, Achilles tendon ruptures are devastating injuries, often resulting in season loss or decreased return to sports level. We aimed to perform a comprehensive video analysis to describe the mechanisms of Achilles tendon rupture as well as body posture in professional athletes. We hypothesized that Achilles tendon ruptures in professional athletes develop with a specific injury mechanism and that body posture at the time of injury varies by sport.

Methods: Of 114 identified Achilles tendon ruptures that occurred in professional athletes between 1970 and 2020, 42 with adequate video data were analyzed for injury mechanism, body posture, and player and sport characteristics by three independent reviewers.

Results: Mean ± SD age of the 42 athletes (41 men and 1 woman) was 28.4 ± 4.26 years. Eighteen athletes played basketball (42.9%), 14 football (33.3%), five soccer (11.9%), three baseball (7.1%), and two rugby (4.8%). Thirty-five patients (83.3%) had noncontact injuries. The most frequent months of injury were January (16.7%) and October (14.3%). During Achilles tendon rupture, the ankle was in dorsiflexion, the body was bent forward, the knee and hip were in extension, and the foot was in a neutral position. Most injuries occurred during take-off/acceleration (40.5%) or stop and turn (38.5%) maneuvers.

Conclusions: In professional athletes, the Achilles tendon most often ruptures during take-off/acceleration. The most common position during rupture is the trunk in flexion, the knee and hip in extension, and the ankle in dorsiflexion. This information can guide professional athletes in terms of physical therapy techniques, including neuromuscular training, proprioception, and balance training specific to preventing Achilles tendon rupture.
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NewsBot · Aug 4, 2024

Surgical Management of Achilles Tendon Ruptures in the United States 2006-2020, an ABOS Part II Oral Examination Case List Database Study
Peter G Brodeur et al
Foot Ankle Orthop. 2024 Jul 30;9(3)

Background: In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume.

Methods: The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends.

Results: The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied.

Conclusion: This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period.
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NewsBot · Aug 9, 2024

Operated and uninjured Achilles tendons show different loading patterns: a shear wave tensiometry study.
Schneebeli, Alessandro and Barbero, Marco and Falla, Deborah and Testa, Enrique and Riegger, Martin and Sangiorgio, Alessandro and Cescon, Corrado
Source

Introduction: The purpose of this cross-sectional study was to test if shear wave tensiometry is able to detect AT loading changes between a surgically managed AT after rupture and the unaffected contralateral tendon. Our secondary aims were to evaluate differences in mechanical properties when measured with myotonometry and morphological properties of the tendons measured with ultrasound imaging. Methods: Twenty-one patients with surgically treated Achilles tendon rupture were investigated from 1 to 4 years after surgery. Tendon load was measured using a shear wave tensiometer composed of an array of four accelerometers fixed on the tendon. Shear wave speed along the Achilles tendon was evaluated at different ankle torque for both the operated and the unaffected side. Mechanical properties of the tendons were evaluated using MyotonPRO and morphological properties using ultrasound imaging. Results: Friedman test showed a significant shear wave speed difference between sides at every ankle joint torque (p<0.05) with a large effect size for the lowest ankle torque and small to medium effect sizes for higher ankle torque. Stiffness, thickness, and cross-sectional area of the operated tendon remain significatively higher compared to the unaffected side. Conclusion: Shear wave tensiometry can precisely detect differences between operated and unaffected AT during a standardized loading procedure. The shear wave speed along the operated tendon, as well as the mechanical and morphological properties, remains higher in the long-term after a rupture. This is the first step towards the implementation of shear wave tensiometry in clinical settings with promising results.
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NewsBot · Aug 15, 2024

The option of transosseous distal suture placement during minimally invasive Achilles tendon repair for high-risk patients can improve outcomes, however does not prevent re-rupture
Michael R Carmont et al
BMC Musculoskelet Disord. 2024 Aug 1;25(1):610

Purpose: Achilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to suture pull-out from the distal tendon stump. The aim of this study was to describe the outcome of ATR patients who received transosseous distal suture placement using a standard technique as a reference.

Methods: Following ATR, patients were evaluated for pre-injury activity level, body weight, location of the tear and size of the distal Achilles tendon stump. Patients considered to be at high-risk of re-rupture: Tegner level ≥ 8, body weight ≥ 105Kg and distal ATR, received transosseous (TO) distal suture placement (n = 20) rather than the usual transtendinous (TT) technique (n = 55). Patient reported outcome measures and functional evaluation was performed at 12 months following repair.

Results: At 12 months follow up both methods resulted in good median (IQR) Achilles tendon Total Rupture Score TO 83.8 (74-88.3) vs. TT 90 (79-94), low increased relative Achilles Tendon Resting Angle TO -3.5˚ (3.6) vs. TT -3.5˚ (3.3) and mean (SD) Single leg Heel-Rise Height Index TO 88.2% (9.9) vs. TT 85.6% (9.9) (n.s.). There were 4 re-ruptures in the high-risk group and 2 in the group receiving TT distal suture placement. All but one of these were traumatic in nature. The mode of failure following TO distal suture placement was proximal suture pull out.

Conclusions: To distal suture placement during minimally-invasive Achilles tendon repair for higher-risk patients can lead to results equivalent to those in lower-risk patients treated with a standard TT MIR technique, except for the re-rupture rate which remained higher. There may be factors that have greater influence on outcome other than suture placement following ATR.
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NewsBot · Aug 28, 2024

Flexor Hallucis Longus Transfer With Concurrent Gastrocnemius Augmentation in Neglected Tendoachilles Tears: A Case Series
Vijayanand B et al
Cureus. 2024 Jul 23;16(7):e65170

The Achilles tendon, the body's largest tendon, is often vulnerable to rupture, primarily as a result of sudden dorsiflexion of a plantar-flexed foot. This injury predominantly affects individuals in their youth and middle age. In this case series, we describe three middle-aged men with neglected insertional Achilles tendon ruptures, each presenting an average 10 cm defect. They underwent a surgical procedure involving flexor hallucis longus (FHL) tendon transfer with concurrent gastrocnemius augmentation. The FHL tendon was repositioned proximally and securely tenodesed to the proximal stump of the excised Achilles tendon. Following this intervention, substantial clinical improvements were observed at the six-month follow-up, with the American Orthopaedic Foot and Ankle Society (AOFAS) score improving from 35 to 85 and the Visual Analog Scale (VAS) pain score decreasing from 8 to 2. These results highlight the efficacy of flexor hallucis longus tendon transfer with gastrocnemius augmentation as a superior treatment option for neglected insertional achilles tendon tears characterized by substantial defects, promising improved functional outcomes and pain relief.
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NewsBot · Sep 9, 2024

Effects of Blood Flow Restriction Rehabilitation after Achilles Tendon Rupture Repair – A Randomized Trial
Bradley Lambert et al
Source

Objectives:
Patients often experience a significant amount of muscle and bone atrophy following Achilles tendon rupture and surgical repair due to mechanical unloading and an inability to safely perform resistance training at intensities sufficient to preserve mass in the early postoperative period. This potentially increases the risk of reinjury, increases recovery time, and delays return to sports. Low intensity resistance training combined with blood flow restriction (BFR) therapy has been shown to induce muscle hypertrophy similar to high intensity exercise while mitigating the risks during the early postoperative period. The objective of this study was to determine if BFR added to the standard postoperative rehabilitation protocol would reduce skeletal muscle and bone atrophy in the lower extremity compared to traditional rehab following Achilles tendon reconstruction. Secondary outcome measures were changes in muscular strength and improvement in functional outcomes.
Methods:
A total of 19 patients undergoing acute Achilles tendon rupture repair were randomized into 2 groups (12 control, 7 BFR). Patients underwent 15 weeks (wks) of postoperative rehabilitation (2/wk) and performed the same standardized protocol. The BFR group performed select exercises under 80% arterial occlusion of the postoperative extremity. Body composition, total lean mass, lower extremity bone mass, thigh lean mass, calf lean mass, and bone mineral density (BMD) of the tibia were measured presurgery, prior to physical therapy (wk3), 8wks post-operatively, and 16wks post-operatively for all subjects. Calf girth, single-leg (SL) squat, single heel raise test, and gastrocnemius and soleus strength were measured in both the operative and contralateral legs at 8wks and 16wks postoperatively. Data were analyzed using a 2(group)x3(time) analysis of covariance repeated on timepoint and covaried on initial measurement values (significance set at p<0.05).
Results:
Only the control group was observed to have lower extremity bone mass loss in the injured limb at the 8wks postoperative (p=0.006) and 16wks postoperative (p<0.001) timepoints (Figure 1). Compared to the control group, the BFR group was observed to have preserved tibia BMD at 16wks postoperative (p=0.016) whereas the control group experienced a significant decrease at 16wks compared to preoperative (p=0.003) (Figure 1). Both groups were observed to have similar increases in gastrocnemius strength at the 8wks (BFR: p=0.004; control: p<0.001) and 16wks postoperative (BFR: p=0.002; control: p<0.001)(Figure 2). However, there was a greater improvement towards achieving limb symmetry in the BFR group at 8wks postoperative (p=0.048) (Figure 2). The BFR group demonstrated greater improvements in soleus strength at 16wks (p=0.043) compared to 4wks postoperative (Figure 2).
Conclusions:
Preliminary findings suggest that the application of BFR to a standardized rehabilitation protocol following Achilles tendon rupture repair may result in preservation of lower extremity bone mass and tibial BMD, greater recovery of calf muscle strength, and greater preservation of calf muscle mass.
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NewsBot · Sep 9, 2024

Paratenon preserving repair of the midsubstance acute Achilles tendon rupture: a systematic review and meta-analysis with best- and worst-case analyses for rerupture rates
Choon Chiet Hong, Dexter Seow, Jin Hean Koh, Stefan Rammelt & Christopher J. Pearce
Archives of Orthopaedic and Trauma Surgery 17 August 2024

Introduction
Paratenon preserving techniques to facilitate acute Achilles tendon rupture repair (AATR) functions by maintaining vascularity and biology for optimal healing response. Therefore, the purpose is to evaluate the outcomes following paratenon preserving repair of the midsubstance AATR. The hypothesis was that paratenon-preserving techniques demonstrate high return to play rates and low complication rates for the repair of the midsubstance AATR.

Materials and methods
A systematic review of the PubMed, Embase, and the Cochrane Library databases was performed by two authors using specific search terms and eligibility criteria. The assessment of the evidence was two-fold: level and quality of evidence. A meta-analysis of proportions for the various complication rates was performed using the restricted maximum likelihood method following the Freeman-Tukey double-arcsine transformation. Fixed effects models were employed if I2 < 25% (low heterogeneity), and random effects models were employed if I2 ≥ 25% (moderate to high heterogeneity).

Results
The pooled return to play rate was 90.3%. The pooled rerupture rate as reported was 0.9% (best-case scenario 0.8% and worst-case scenario 6.8%). No meaningful subgroup analysis for rerupture rates could be performed based on the meta-regression. The pooled complication rate other than reruptures was 4.8%. The pooled infection rates were 0.3%, DVT rates were 1.6%, and sural nerve injury rates were 0.3%.

Conclusions
Paratenon preserving techniques that are minimally invasive in nature demonstrated safe and favorable outcomes with high return to play rates and low complication rates for the repair of the midsubstance AATR.
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NewsBot · Sep 9, 2024

Comparison of different immobilisation durations following open surgery for acute achilles tendon rupture: a prospective cohort study
Yuan Cao et al
J Orthop Surg Res. 2024 Aug 21;19(1):497

Background: In recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair.

Methods: This study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected.

Results: The recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences.

Conclusions: Immobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications.
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NewsBot · Sep 11, 2024

Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation
Han Xue et al
Sci Rep. 2024 Aug 1;14(1):17815

Achilles tendon reconstruction is an effective method of repairing Achilles tendon rupture defects. We introduce a new approach for Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft. The study aimed to evaluate the clinical role of this new Achilles tendon reconstruction. We retrospectively enrolled patients who underwent Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft for acute Achilles tendon rupture defects from 2016 to 2021. The clinical and radiological results were assessed at the preoperative and the final postoperative follow-up with Visual Analog Score (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores and Achilles tendon Total Rupture Scores (ATRS). Besides, at the last postoperative follow-up, the difference in ankle range of motion between the two side of the patients and the incidence of postoperative complications were recorded. Results revealed patients had significantly lower VAS and higher AOFAS and ATRS (P < 0.01). Compared to the healthy ankle, the operative ankle showed significant deficits in ankle range of motion (P < 0.01). Additionally, radiological results showed no noticeable signs of tunnel enlargement in the calcaneus and no patient had re-rupture. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft is an effective treatment option for patients with acute Achilles tendon rupture with large defects and have high postoperative exercise demands.
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NewsBot · Sep 16, 2024

Achilles tendon ruptures related to fluoroquinolone use – How can we manage these patients? A case series
L. Miller Alison et al
The Foot Volume 61, December 2024, 102131

Highlights
•Largest case series of Fluoroquinolone-related Achilles tendon ruptures.
•All patients managed through functional rehabilitation.
•Improvements seen in ATRS score but this may not be appropriate for this cohort of patients.
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Background
Fluoroquinolone antibiotics can increase the risk of tendon rupture. Treatment of these Achilles ruptures can be difficult due to comorbidities.

Methods
A case series of 13 consecutive patients with Achilles ruptures following fluoroquinolone use were identified over a 2 year period through the Achilles Tendon rupture clinic and managed conservatively using functional rehabilitation. Follow-up with the Achilles tendon rupture score (ATRS) was completed at 3 months, 6 months and 12 months.

Results
Improvements were seen in ATRS scores over 12 months.

Conclusions
This case series is the largest published. Improvements were seen in ATRS scores indicating that this cohort can be managed successfully using functional rehabilitation after fluoroquinolone-induced Achilles rupture.
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NewsBot · Sep 19, 2024

Operative, nonoperative management of Achilles tendon rupture yielded similar outcomes

Key takeaways:

Results showed more patients in the operative group achieved the minimal clinically important difference by 12 weeks.

There was no significant difference in re-rupture rates between the two groups

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NewsBot · Sep 19, 2024

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia
Andrej Čretnik, Roman Košir
Foot (Edinb). 2024 Sep:60:102124

Objective: The optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia.

Methods: In a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29-71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29-57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed.

Results: There was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters.

Conclusion: Early dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol.
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NewsBot · Sep 22, 2024

This clinical trial was just registered:
Achilles Tendon Rupture - Intervention With Electrical Stimulation (C-NMES-ATR)

Acute Achilles tendon rupture (ATR) is an injury that is commonly associated with complications, such as blood clotting, muscle loss and tendon lengthening, all of which affect the long-term outcome and return to sports. These complication are related to the treatment of ATR with lower leg immobilization in a boot.

The investigators aim to demonstrate that an intervention with calf neuromuscular electrical stimulation (C-NMES) during leg immobilization after ATR can 1) reduce blood clots, 2) lower the degree of muscle loss, 3) decrease tendon lengthening and 4) improve long-term outcome.
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NewsBot · Sep 24, 2024

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia
Andrej Čretnik, Roman Košir
Foot (Edinb). 2024 Sep:60:102124

Objective: The optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia.

Methods: In a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29-71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29-57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed.

Results: There was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters.

Conclusion: Early dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol.
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NewsBot · Sep 24, 2024

Clinical and biomechanical comparison of suture-external button versus interference screw associated with V-Y advancement or turndown flaps for flexor hallucis longus transfer in chronic Achilles tendon rupture
A R Vosoughi et al
Musculoskelet Surg. 2024 Sep 9

Purpose: Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between two techniques for fixation of flexor hallucis longus tendon to the calcaneus: interference screw and suture-external button.

Methods: Twenty-five patients participated in this retrospective comparative study. All patients underwent short harvest FHL tendon transfer for chronic AT rupture were asked for a follow-up visit, at least one year following surgery. The outcomes were evaluated by visual analog scale (VAS), AOFAS ankle-hindfoot score, and VISA-A questionnaire. Ankle ROM with possible restriction in addition to isokinetic strength of ankle plantar- and dorsiflexors was assessed.

Results: No statistically significant difference was observed between the groups for pain (P = 0.81), AOFAS ankle-hindfoot scale (P = 0.97), and VISA-A (P = 0.44). Notably, more decrease in ankle dorsiflexion was seen in interference screw group in comparison with suture-external button group (4.4 ± 6.6 vs. 9.5 ± 6.1 degrees, P = 0.06). The difference of active dorsiflexion between operated and non-operated side in interference screw group was statistically significant (P = 0.02). Biotenodesis screw imposed more limb asymmetry in comparison with suture-external button technique.

Conclusions: Fixation of transcalcaneal FHL tendon transfer for chronic AT either by interference screw or suture-external button has encouraging postoperative clinical results. Although ROM of the ankle joint reduced in both techniques, interference screw may result in more reduction in dorsiflexion of the ankle.
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NewsBot · Oct 4, 2024 at 7:22 AM

Acute Achilles tendon rupture: diagnosis and management

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

The most frequent heel lift height to treat Achilles tendonitis

Testosterone replacement therapy is associated with increased odds of Achilles tendon injury

Achilles Tendon and Femoral Cartilage Thickness in Flatfoot

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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

The most frequent heel lift height to treat Achilles tendonitis

Testosterone replacement therapy is associated with increased odds of Achilles tendon injury

Achilles Tendon and Femoral Cartilage Thickness in Flatfoot

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