Achilles tendon rupture

NewsBot · Nov 7, 2025

Retrospective Epidemiological Study of Achilles
Tendon Ruptures
Edmond F. Iradukunda , Abdul Hadi Kafagi , Mustafa Farooqi , Anand Pillai
Source

Whilst the epidemiology of Achilles tendon ruptures (ATRs) is well known in the context of other countries,
not many epidemiological studies have been conducted in the UK, demonstrating the lack of recent, reliable
data relevant to our population context.
The approach taken was retrospective data collection of ATRs and relevant history from participants’
electronic patient records (EPR), followed by a telephone interview to confirm and investigate data points
not included in patient notes.
From a sample of 88 participants, 76% were male, and the median age was 44. The most prevalent activity
and mechanism of injury was playing football (39%), and accelerating from a stationary position (30%). ATRs
were predominantly sports-related (67%), and the incidence of sports-related ATRs and total ATRs was
greatest during summer (34%), followed by spring (30%). The median (IQR) age of participants with sports-
related ATRs was 40.0 (35.0 - 45.5) years, compared to 65.5 (54.0 - 73.5) years for non-sports-related ATRs.
In this sample, ATRs most commonly occur in middle-aged men in a sporting context during the spring and
summer seasons. Non-sports-related ATR incidence is greater in older age groups. These results are
consistent with both local British studies and international studies, but limitations to this study highlight
the need for further research with a similar methodology and greater scale, which would aid in identifying
high-risk groups that could benefit from tailored injury prevention strategies
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NewsBot · Nov 11, 2025

Return to Running After Achilles Tendon Repair: How Do US Navy Service Members’ Physical Readiness Tests Change After Undergoing an Achilles Tendon Repair?
Vitha, Anneliese et al
Clinical Orthopaedics and Related Research 483(11) 2012-2018, November 2025. | DOI: 10.1097/CORR.0000000000003590

Background

Achilles tendon ruptures are common injuries among adults that can cause substantial pain and disability. While prior studies have reported on return-to-play rates in athletes, limited data exist regarding functional outcomes in both runners and within a military population; such data may also help inform care for active civilian patients.
Questions/purposes

(1) How do US Navy service members undergoing Achilles tendon repairs perform on the cardiovascular section of their physical readiness test preoperatively compared with postoperatively? (2) How do US Navy service members undergoing Achilles tendon repairs perform on the cardiovascular section of their physical readiness test on consecutive postoperative physical readiness tests?
Methods

This was a retrospective analysis of data from 2014 to 2020 from the outpatient Military Health System Medical Data Repository and Physical Readiness Information Management System. Achilles tendon rupture was identified using a procedure code from the Medical Data Repository (code 27650). The Physical Readiness Information Management System has electronic records of all the physical readiness tests completed by Navy personnel. As such, the study was limited to Navy personnel. The study cohort included 1057 Navy personnel who sustained an Achilles tendon rupture and underwent operative repair. Service members who underwent more than one operative repair during the study period (9.8% [104 of 1057]) were excluded. Another 41.7% (441 of 1057) were excluded for not having a valid cardiovascular physical readiness test within 30 to 730 days before or 90 to 730 days after operative repair. Forty-three percent (451 of 1057) of Navy personnel were included in the analyzed cohort. These service members underwent one Achilles tendon repair and had cardiovascular physical readiness test assessments from before and after the operative repair. The cardiovascular component was stratified into four subgroups: individuals who biked before and after Achilles tendon rupture (35% [156 of 451]), those who ran (28% [127]), those who ran before Achilles tendon rupture but transitioned to another cardiovascular test after operative repair (32% [144]), and those who performed an alternative cardiovascular test (5% [24]). Cardiovascular assessments performed 30 to 730 days before were utilized to capture all patients who had completed an assessment within the 2 years prior to sustaining the Achilles tendon rupture. Postoperatively, cardiovascular assessments would not typically be recommended by the orthopaedic surgeon until at least 90 days after the procedure. Postoperative cardiovascular assessments were included up to 2 years postoperatively to evaluate initial performance after surgical repair and subsequent performances if numerous physical readiness tests were completed after the repair. The study cohort was predominantly male (94.4%) with a mean age of 33 years. Differences in physical readiness test scores before and after Achilles tendon repair for the bike and run subgroups were compared while adjusting for age, time since procedure, and sex. Changes in physical readiness test categories before and after Achilles tendon rupture were evaluated by converting the categories into discrete scores (outstanding = 5, excellent = 4, good = 3, satisfactory = 2, probationary = 1, failure = 0) and using a paired t-test for all cardiovascular subgroups. For example, a US Navy male age 30 to 35 years would receive an outstanding (discrete score = 5) if his 1.5-mile run time was < 10 minutes, while he would receive a failure, discrete score of 0, if his 1.5-mile run time was > 14 minutes and 30 seconds. The proportions of individuals who improved, decreased, or maintained fitness categories were reported. The analysis described was repeated for a subgroup of individuals who completed two postoperative cardiovascular physical readiness tests.
Results

We found that individuals performed worse on their physical readiness tests after Achilles tendon rupture compared with their preinjury scores for the biking subgroup (10 seconds; p = 0.02) and the 1.5-mile running subgroup (41 seconds; p < 0.001). When analyzing the changes in fitness category levels, there was no difference for the biking subgroup. Eighty-five percent (132 of 156) of individuals maintained or improved their physical readiness test scores after Achilles tendon rupture for the biking subgroup, in contrast to 74% (106 of 144) for the run-to-another subgroup and 69% (88 of 127) for the running subgroup. There were between 0% (0) and 1.5% (2) first-time physical readiness test failures after Achilles tendon repair. Last, 165 members underwent additional analysis with two postoperative physical readiness test scores available for the biking and running subgroup. Participants improved their running scores (18 seconds; p = 0.004) but not their biking scores.
Conclusion

Our findings can help orthopaedic surgeons to counsel active individuals, especially male runners. Runners undergoing Achilles tendon repair may run more slowly (approximately 41 seconds on a 1.5-mile run); however, these times will tend to improve over time even 1 year after Achilles tendon repair. Still, numerous unanswered questions remain regarding whether these changes in run times persist when compared with nonoperatively treated Achilles tendon ruptures, the specific type of surgical procedures performed, and the postoperative protocol utilized, which are all avenues for future research.
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NewsBot · Nov 22, 2025

Does Suture Configuration Matter in Achilles Tendon Repairs?
Nathan Benner et al
Cureus. 2025 Oct 20;17(10):e94982.

Background: The human Achilles tendon is functionally important for dynamic activities and is a common site of tendon rupture, resulting in pain, weakness, and removal from sport. While treatment options vary and the opinions regarding optimal management are not uniform, percutaneous repair through commercially available guides is one option that has been used in the United States.

Hypothesis/purpose: The purpose of this study was to test the mechanical properties of four common suture configurations in the repair of Achilles tendon ruptures.

Study design: This biomechanical study utilized porcine toe flexor tendons as an analogue for the human Achilles tendon.

Methods: Simulated rupture was performed, and tendons were repaired using a percutaneous guide. The technique was uniform with predetermined allotment into one of four groups based on suture configuration (single or double locked) and type (round or flat), with a total of 10 specimens in each group. Specimens then underwent a static creep test, a dynamic load creep test, and finally a load-to-failure test. An analysis of variance was performed to test for differences between the variables, followed by pairwise comparisons using independent t-tests to assess inter-group differences if significant effects were found, adjusted for multiple comparisons.

Results: No significant differences were seen between conditions for the creep tests. The suture configuration used was determined to have a significant effect on the maximum load to failure of the constructs (p = 0.018) and maximum stress in the construct during the load-to-failure test (p = 0.019). Double tape had a significantly greater load to failure than the single round and single conditions and reached greater stresses before failure (respectively). No significant differences were found between the double tape and double round techniques, nor between the double round and either of the single techniques for any of the load-to-failure variables.

Conclusion: The results of this study, using a porcine model to simulate a minimally invasive technique for Achilles tendon repairs, suggest that the use of a double-locked tape suture configuration leads to a stronger overall construct.
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NewsBot · Dec 1, 2025

Suspected Achilles Tendon Ruptures and the Course of Action: Assessing Compliance With Local Protocols
Hassan Imtiaz et al
Cureus. 2025 Oct 23;17(10):e95225.

Introduction: Achilles tendon rupture is a significant injury that can cause prolonged disability and impact quality of life. It typically occurs during sports or activities involving sudden loading of the tendon, most often in active adults. Early recognition and appropriate management are vital to reduce complications, optimise healing, and support timely return to function. Clinical pathways provide structured guidance for consistent care, including immobilisation, prophylaxis, imaging, and specialist follow-up. Variation in adherence to such pathways may compromise outcomes. Clinical audit provides a means to evaluate current practice against pathway standards, while closed-loop audits allow assessment of targeted interventions aimed at improving compliance.

Methods: A closed-loop audit was performed at a large district general hospital to assess compliance with a locally developed Achilles tendon rupture pathway. The first cycle reviewed 138 patients between October 2022 and September 2023. Following the dissemination of results, display of posters in relevant areas, and introduction of a dedicated "Ultrasound Achilles" request form, a second cycle reviewed 44 patients between March and June 2024. Standards included venous thromboembolism (VTE) prophylaxis, weight-bearing advice, immobilisation, ultrasound imaging within 14 days, and referral to a virtual fracture clinic (VFC). Data were analysed using chi-squared tests.

Results: In cycle 1 (n = 138), compliance was as follows: VTE prophylaxis 110/138 (80%); immobilisation in boot 110/138 (80%); ultrasound within 14 days 59/138 (43%); non-weight-bearing advice 91/138 (66%); and VFC referral 132/138 (96%). In cycle 2 (n = 44), after interventions including pathway dissemination and the introduction of a dedicated "Ultrasound Achilles" request form, compliance improved in several domains: VTE prophylaxis 35/44 (80.5%, p = 0.91); immobilisation 38/44 (86%, p = 0.04); ultrasound within 14 days 26/44 (59%, p = 0.03); non-weight-bearing advice 29/44 (66%, p = 0.99); and VFC referral 44/44 (100%, p = 0.01). No re-ruptures or venous thromboembolic events were recorded in either cycle.

Conclusion: Targeted interventions improved compliance with several aspects of the pathway, though VTE prophylaxis prescribing showed little progress. Ongoing education, structured pathways, and regular re-audits are essential to sustain improvement and ensure optimal outcomes.
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NewsBot · Dec 2, 2025

Management and Functional Outcomes After Postoperative Achilles Tendon Infection: A Retrospective Case Series
Saanchi K. Kukadia, et al
Source

Background:
Achilles tendon repairs and reconstructions have historically been associated with high infection rates because of poor vascularity. However, newer surgical infection control strategies can reduce morbidity associated with infection. We hypothesized that with appropriate treatment and management of these infections, patients can reach high levels of physical function with minimal pain comparable to those without postoperative infection.
Methods:
Chart review was conducted for all patients who underwent Achilles tendon surgery at our institution between 2011 and 2020. We identified patients who experienced postoperative wound infection requiring return to the operating room. Clinical outcomes, antibiotic type, and duration were recorded. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were sent to all patients at a minimum of 1 year postoperatively.
Results:
A total of 1148 patients underwent Achilles tendon surgery, of whom 23 patients (2.0%) experienced a postoperative wound infection requiring surgical intervention. Ten patients who presented from outside institutions with an existing Achilles infection were included for management/outcome descriptions but excluded from risk-factor incidence analyses because of missing index-procedure details, increasing the overall cohort to 33. Among 604 acute repairs, 8 patients (1.32%) developed infections, compared with 15 of 544 chronic tendinopathy cases (2.75%). In chronic cases, graft use was associated with higher infection rate (8.96% vs 0.73%, P < .0001). Patients with postoperative infection demonstrated significantly worse in physical function (46.9 vs 51.6, P = .01) and pain interference (52.1 vs 48.1, P = .03) PROMIS scores. No other PROMIS domains showed significant difference between the 2 cohorts. By 18 months postoperatively, 26 of the 33 patients (78.78%) could toe-walk on the affected side with little to no difficulty.
Conclusion:
Early, aggressive management yields good recovery after postoperative infection; however, residual deficits in function and pain persist compared with uninfected peers in our cohort at 2-year follow-up.
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NewsBot · Dec 14, 2025

Endoscopic Assistance in Minimally Invasive Repair of Acute Achilles Ruptures: A Prospective Observational Study Comparing Endoscopic-Assisted, Minimally Invasive, and Open Techniques
Paolo Ceccarini et al
J Clin Med. 2025 Nov 17;14(22):8117.

Background: The optimal management of acute Achilles tendon (AT) ruptures remains debated. Historically, surgical treatment has been preferred over conservative management because of a lower risk of rerupture. In recent decades, minimally invasive (MIS) and percutaneous techniques have been introduced to reduce the complications associated with the traditional open surgery. Comparable clinical outcomes have been demonstrated, with a lower rate of general complications but a higher risk of sural nerve palsy. Endoscopic assistance has been finally proposed to improve intraoperative visualization and potentially decrease this risk, although its actual potential benefit remains uncertain. Methods: A prospective observational study including a total of 94 patients who underwent surgical treatment for acute subcutaneous AT rupture was conducted. 60 of the patients were male and 34 were female, with a mean age at the time of surgery of 42.5 [18-78] years. The patients were then divided into three groups according to the surgical procedure performed: endoscopic-assisted MIS technique (A, n = 30), Ma-Griffith minimally invasive technique (M-G/MISI) (B, n = 34) and traditional open surgery (C, n = 32). Same post-operative protocol. The mean follow-up was 32 months (24-60 months). Patients were evaluated by time taken to return to driving (RTD), to their usual work activities (RTW), and, in active patients, to sports activities (RTS) at a level comparable to that prior to the injury was recorded. Clinical outcomes were evaluated with Achilles tendon Total Rupture Score (ATRS) and Ankle Hindfoot American Orthopaedic Foot and Ankle Society (AH-AOFAS) scores. Results: Significant differences among groups were found for RTD (p = 0.001), RTW (p < 0.001), and ATRS (p < 0.001), while RTS (p = 0.46) and AOFAS (p = 0.41) did not differ significantly. Post hoc analyses showed that the M-G/MISI group achieved faster return to driving and work and higher ATRS compared with the open group (all p < 0.05). No significant differences were detected between M-G/MISI and endoscopic-assisted techniques. Conclusions: All three techniques achieved good functional outcomes and low complication rates. Endoscopic assistance allowed visualization of suture passage and confirmation of gap reduction, but no superiority was observed in clinical outcomes or sural nerve safety. The M-G/MISI approach was associated with faster return to activity and higher ATRS compared with open repair
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NewsBot · Dec 19, 2025

Retrospective Analysis of Malpractice Claims Following Achilles Tendon Rupture
Haad A Arif et al
Foot Ankle Orthop. 2025 Dec 15;10(4):24730114251397974.

Background: Achilles tendon rupture (ATR) is among the most common foot and ankle injuries, with a rising incidence of up to 50 per 100 000 persons. We sought to investigate the medicolegal characteristics associated with ATR.

Methods: Westlaw Precision, an online, legal database from across the United States, was queried for all jury verdicts and settlements pertaining to "malpractice" and "Achilles" tendon rupture from 1980 to 2024. Data extracted included date and state of claim filing, patient and defendant demographics, jury verdict, monetary payments, basis of litigation, and listed patient complications.

Results: A total of 50 of 236 claims were included in this analysis. A defendant verdict was reached in 82% of claims. The average indemnity payment was $431 405. Orthopaedic surgeons were named in 44% of claims. Nearly one-half of claims were levied due to a delayed or missed diagnosis (24%) or insufficient informed consent (18%). Subsequent surgery was the most frequent complication of the alleged negligence (18%); however, patient death occurred in 14% of claims as well. Patient disagreement with the treatment strategy was seen in 18% of claims.

Conclusion: Achilles tendon rupture is an infrequent source of medicolegal burden within foot and ankle treatment. Such legal action most commonly arises from diagnostic delays, insufficient informed consent, and patient disagreement with the treatment strategy. Early recognition, comprehensive counseling on management options and risks, and shared decision making are essential strategies to reduce litigation risk and improve patient outcomes.
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NewsBot · Dec 19, 2025

A Systematic Review on the Efficacy and Safety of Platelet-Rich Plasma in the Management of Achilles Tendon Rupture
Mohammed Alharbi
Indian Journal of Orthopaedics

Background

The Achilles tendon is the most robust tendon in the human body; yet ruptures of the Achilles tendon are prevalent. Their prevalence is greatest among middle-aged individuals, perhaps due to the increased participation of this demographic in sports. There is a huge controversy regarding the treatment of Achilles tendon ruptures with platelet-rich plasma (PRP) and whether it is associated with improvement in outcomes or not; therefore, I conducted the current systematic review to investigate the evidence from published articles assessing the effectiveness of PRP in patients with Achilles tendon ruptures.
Methods

This systematic review and meta-analysis was performed by searching for all eligible publications on PubMed, Web of Science, and Scopus from their creation to November 2024. A search strategy based on three primary keywords and their corresponding Medical Subject Headings (MESH) terms: “Platelet-rich plasma” AND “Achilles tendon” AND “Rupture.” I systematically reviewed the included articles and a narrative synthesis of data was conducted to present the efficacy and safety parameters in addition to a summary of findings of the included studies.
Results

After screening, eight articles were included in the present systematic review. The studies provide a range of findings on the effectiveness of PRP in the treatment of Achilles tendon ruptures, with most research suggesting limited clinical benefit. In contrast, Zou et al. offered a differing perspective, suggesting that PRP may serve as a biological augmentation in surgical repair, potentially improving short- and mid-term outcomes. Overall, while some studies suggest possible short-term benefits, the majority do not support PRP as a valuable addition to Achilles tendon rupture treatment protocols.
Conclusion

From the systematic synthesis of the included studies, I observed controversial findings regarding the efficacy of PRP in the management of Achilles tendon ruptures with more data supporting no benefit. However, comprehensive data and strong evidence are still lacking to depend on in the use of PRP and its different types and constituents in the treatment process of Achilles tendon ruptures. This shows the importance of continued research to fill the gap in this area.
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NewsBot · Dec 20, 2025

The Usefulness of Concomitant Ultrasound Guidance With Surgery for Acute Achilles Tendon Rupture Using an Internal Brace
Shuichi Chida et al
Cureus. 2025 Feb 20;17(2):e79340.

Background This study investigated the usefulness of intraoperative ultrasonography in the treatment of acute Achilles tendon rupture (ATR) using an internal brace (Achilles Midsubstance SpeedBridge, Arthrex Inc., Naples, FL), a technique that provides strong internal fixation. Methodology Forty-three patients were included and divided into two groups: Group A (n = 22), which received ultrasonography, and Group B (n = 21), which did not. In Group A, ultrasonography was used during suturing with a specialized jig to confirm the suture needle's position at the center of the proximal stump. Postoperative care in both groups involved initiating active dorsiflexion exercises on the day following surgery and permitting weight-bearing without orthosis once 0° dorsiflexion was achieved. The operative time, Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, T2-weighted magnetic resonance imaging (MRI) findings at three months postoperatively, and complications were evaluated. Results Group A had a significantly shorter operative time (41.9 ± 7.5 minutes vs. 52.1 ± 6.5 minutes, P < 0.001) and a lower percentage of high-intensity areas on T2-weighted MRI (1.76% ± 2.68% vs. 8.74% ± 7.02%, P < 0.001) compared to Group B. No significant difference was observed in JSSF scale scores (P = 0.948). Additionally, no cases of re-rupture or wound infection were reported in either group. Conclusions Intraoperative ultrasonography in conjunction with this method may enable precise and reliable suturing, facilitating strong internal fixation and potentially enhancing clinical outcomes.
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NewsBot · Dec 25, 2025

PERCUTANEOUS REPAIR VERSUS NONOPERATIVE MANAGEMENT OF ACUTE ACHILLES TENDON RUPTURE
Salman Sadiq et al
The British Orthopaedic Foot & Ankle Society (BOFAS) Annual Congress 2025 (second meeting), Glasgow, Scotland, 26–28 November 2025.

Introduction:

The aim of this study was to assess any difference in patient reported outcomes between patients managed operatively with percutaneous repair versus non-operatively following an acute Achilles tendon rupture.
Method:

This was a single-centre prospective cohort study over a 10-year period performed at University Hospital North Midlands. Patients were asked to fill an Achilles tendon Total Rupture Score (ATRS) at 3-month, 6-month and 12-month intervals post injury.

Patients were followed up for up to 12 months. Statistical significance was deemed if p<0.05.
Results:

181 patients were included who underwent percutaneous repair with an average age of 46.2 years (SD 12.8). In the non-operative group, 193 patients were included with an average age of 52.8 years (SD 14.3). At 12 months, 98 patients from the operative group (54%) and 103 patients from the non-operative group (53%) filled the ATRS questionnaire.

At 3-month and 6-month intervals, there was no statistically significant difference in ATRS scores (p= 0.17 and p=0.70 respectively). At 12 months, there was a statistically significant difference in ATRS scores (p<0.001) in favour of the operative group. When individual ATRS questions were analysed at 12 months, there was a statistically significant difference in favour of the operative group (p<0.002), especially in relation to intense physical activity. The improvement was seen in all age groups.

Four patients in the non-operative group sustained a DVT or PE and five patients had a re-rupture. In the operative group, one patient sustained a DVT, one patient was found to have a surgical site infection, and three patients had a re-rupture.
Conclusion:

Patients undergoing percutaneous repair have improved ATRS scores at 12 months. Percutaneous repair is therefore a safe and valid management option, especially for highly active patients or heavy labourers. Those patients who do not require these attributes may benefit from non-operative intervention.
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NewsBot · Dec 30, 2025

An Epidemiological Review of the Impact of COVID-19 on Achilles Tendon Rupture Injuries, Experience from a Large London District General Hospital
Lena Al-Hilfi et al
Source

Background: During the lockdown for COVID-19, hospitals experienced a reduction in the number of trauma admissions related to high energy, sport, and occupational injuries. As lockdown measures began to ease, hospitals experienced a high admission rate of patients presenting with Achilles Tendon Rupture [ATR]. However, in the post-pandemic phase, the number of cases reduced. The aim of this paper is to report changes in incidence and identify changes in demographics, mechanism of injury, and Achilles Tendon Rupture management pre- and post-pandemic.

Subjects and Methods: We undertook a review during six different time periods of our Achilles Tendon Rupture patients, the time periods included: pre-pandemic, during the first after the first lockdown, during the second lockdown, after the second lockdown and the post-pandemic period. Patient’s demographics, mechanism of injury, past medical history, the use of steroids and patient management, Achilles tendon Total Rupture Score (ATRS) were all included.

Results: One hundred and sixty-three patients were included in the study. During the second lockdown [1st January 2021- 11th April 2021], the average age of patients was significantly lower than any other group [p <0.005]. 40% of patients after the first lockdown [August 2020- December 2020] were treated surgically and this was significant [p-value <0.005], during all other time periods; the vast majority of patients were treated conservatively. For the entire cohort, 71.78% of patients were treated conservatively, whilst the other 28.22% were treated surgically. There was no statistical difference in the Achilles Tendon Rupture Score-based [p-value - 0.729] when comparing the management of Achilles Tendon Rupture, at least 8 months post-treatment.

Conclusions: During each national lockdown, there was a decrease in the number of patients who presented with Achilles Tendon Rupture to hospital. Following the second lockdown, the number of patients who presented with ATR has significantly increased. However, in the post-pandemic phase, the number of cases decreased again. The study also found no significant difference in long-term outcomes as measured by the Achilles Tendon Rupture Score (ATRS), regardless of treatment approach. these findings suggest that the pandemic had a transient but marked impact on Achilles Tendon Rupture incidence, and further research is needed to explore the underlying mechanisms of this pattern, as well as the long-term outcomes and potential preventive strategies for Achilles Tendon Rupture in the post-pandemic era.
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NewsBot · Dec 31, 2025

Musculoskeletal Science and Practice
Structure and function of the Achilles tendon and plantarflexors after non-surgical management of Achilles tendon rupture: A cross-sectional study
Samuel Briggs-Price et al
Musculoskeletal Science and Practice Volume 81, February 2026, 103459

Highlights

•
Tendon remodelling may occur post ATR with CSA 28 % lower from week 10 to week 52.
•
There is persistence of fibrillar disorganisation 12 months after rupture.
•
Participants had a plantarflexor deficit of 33 % at 12 months after rupture.

Abstract
Background
Achilles tendon rupture (ATR) impacts the structure and function of the tendon and triceps surae. We aimed to describe recovery at different time points after injury using ultrasound imaging, strength testing and patient reported outcomes.
Methods
Cross-sectional study design, collecting data from 15 different non-surgically managed participants at six independent rehabilitation time points (week 0, 8, 10, 16, 26, 52 post ATR). Outcomes included ultrasound tissue characterisation (UTC), isometric plantarflexor strength, Achilles tendon rupture score (ATRS), Euroqol 5-dimension, hospital anxiety and depression scale and Tampa Scale for Kinesiophobia. UTC echo type percentage is reported as aligned fibrillar structure (AFS) and disorganised fibrillar structure (DFS).
Findings
Participants mean (SD) age was 48 years (15.8), 91 % male, body mass index 29kg/m2 (4.3) and 54 % was white British. Primary mechanism of injury was sport (71 %).
Ruptured tendon cross-sectional area (CSA) was 303.55 mm2 (90.43) at 10 weeks and 218.18 mm2 (61.82) at 52 weeks post ATR. For the ruptured tendon, later assessment time points were associated with decreased AFS but had no association with DFS.
Isometric plantarflexor strength on the ruptured limb at 52 weeks was 61.3 kg (20.8) or 0.7x bodyweight (BW). Non-ruptured plantarflexor strength was 93.3 kg (29.5) or 1.1x BW. Leg symmetry index at 52 weeks was 67 %. ATRS at 52 weeks was 75.1 (16.5).
Conclusion
Substantial tendon remodelling may occur during the initial 52 weeks post ATR, CSA was 28 % lower from 10 weeks to 52 weeks. At 52 weeks there was persistence of fibrillar disorganisation, isometric plantarflexor weakness and reduced function.
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NewsBot · Dec 31, 2025

What is the experience of healthcare professionals managing Achilles tendon ruptures in the National Health Service (NHS)?-a qualitative interview study in the United Kingdom
Samuel Briggs-Price et al
BMJ Open. 2025 Oct 17;15(10):e107575.

Objective: To explore National Health Service (NHS) healthcare professionals' experiences of delivering rehabilitation for patients with Achilles tendon rupture (ATR).

Design: Qualitative study using semistructured interviews and reflexive thematic analysis.

Setting: NHS hospital sites in the United Kingdom, providing non-surgical ATR management using the Leicester Achilles Management Protocol (LAMP).

Participants: Twenty-one NHS healthcare professionals, including physiotherapists and orthopaedic consultants with a mean of 10.8 years of clinical experience, purposively sampled based on profession and experience managing ATR.

Results: Three main themes were identified: (1) clinical training on Achilles tendon ruptures, (2) rehabilitation following ATR and (3) the NHS service delivering rehabilitation. Participants reported limited training on ATR, leading to reduced confidence and slower rehabilitation progressions. Fear of re-injury influenced clinical decision-making, while discharge decisions were goal-oriented but constrained by service limitations.

Conclusions: This study highlights limited clinical training, inconsistent rehabilitation practices and NHS service constraints that collectively slow rehabilitation progress and affect return to sport following ATR. Enhanced training, service development and greater standardisation of ATR rehabilitation pathways are recommended to improve patient outcomes.
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NewsBot · Jan 3, 2026

Comparing Quantification Methodologies for the Single-Leg Heel-Rise in Patients Following Operative and Non-Operative Management for Achilles Tendon Rupture
Rebecca Franklin, Josh Garofalo, MD, Sophie Zhu, MD, Monther Abuhantash, MD, Sheila McRae, PhD, Robert Longstaffe, MD, FRCSC, Dan Ogborn, PT, PhD
IJSPT. 2026;21(1):26-33. doi:10.26603/001c.153965

Background

The Single-Leg Heel-Rise test (SLHR) is commonly used to determine the functional status of patients following Achilles tendon rupture (ATR). Several methods exist to quantify performance variables during the SLHR including repetition counting, linear position transducers (LPT) and motion capture/analysis systems; however, they have not been directly compared following operative or non-operative management of ATR.
Hypothesis/Purpose: The purpose of this study was to compare three methods to quantify repetition number, heel-rise height, and total work during the SLHR test in patients managed either operatively or non-operatively for ATR.
Study Design

Cross-sectional study
Methods

Twenty-four patients who underwent either operative or nonoperative treatment for complete ATR completed SLHR to failure on a 10° angle board. LPT, two-dimensional motion capture, and the Calf Raise smartphone application recorded heel-rise repetitions and height. Intraclass correlation coefficients and Bland-Altman plots (95% limits of agreement) compared devices. Work was reported as absolute values and limb symmetry index. Two-way analyses of variance were completed for all variables.
Results

In this sample of 17 males and 7 females (operative [n=12; 39.0±8.9 years; 9 male] and non-operative [n=12; 46.2±14.1 years; 8 male] groups) strong, positive correlations were demonstrated between all devices, with the highest occurring between motion capture and the app (r2 =0.997). Bland-Altman Limits of Agreement showed wide limits of agreement across all methods. Peak and accumulated heel-rise height was reduced on the affected limb when measured by all devices, translating to reduced affected limb total work (mean difference: motion capture -403.5 Joules [J] (95%CI -41.5–902.6), app -434.7 J (95%CI -924.3–54.8), and LPT -370.4 J (95%CI -802.6–61.9).
Conclusion

LPT, motion capture, and the calf raise app can be used to quantify repetitions, work, and heel-rise height in patients following ATR. However, device values should not be used interchangeably due to wide limits of agreement across methodologies.
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NewsBot · Jan 10, 2026

Epidemiology and Complications of 18,061 Achilles Tendon Rupture Repairs in the United States, 2015-2024 (TriNetX)
Lauren A Rodio et al
J Foot Ankle Surg. 2026 Jan 7:S1067-2516(25)00387-4.

Background: There is a lack of recent, nationally representative reporting of Achilles tendon rupture (ATR) repair epidemiology.

Purpose: To evaluate the incidence and prevalence of ATR repairs in the US in the last decade and assess medical and orthopedic complications post-ATR repair.

Study design: Retrospective cohort study.

Methods: The TriNetX database was used to identify US patients who experienced an ATR repair from 2015-2024. The primary outcome was incidence proportion (IP), stratified by sex and age. Rates of medical complications (30, 60, 90 days) and orthopedic complications (1, 2 years) were assessed.

Results: 18,061 patients had an ATR repair from 2015-2024. In 2024, the IP of ATR repairs was 7.28 (95% CI 6.99-7.59) per 100,00 patients, significantly increased from 2015. The annual percent change in IP was 12.8% % per year. Males comprised 65% of the cohort and consistently had higher IP than females. The mean age was 31 ± 7 years and the highest IP in 2024 was in those aged 30-39. Stratified by age and sex, males aged 25-29 experienced the most ATR repairs overall (60.94 (95% CI 58.14-63.87) per 100,000 patients), while the peak in female ATR repairs was in females aged 45-49 (23.08 (95% CI 21.45-24.84) per 100,000 patients). There were relatively low rates of all medical and orthopedic complications assessed.

Conclusions: ATR repair incidence, which is especially high among young men, is increasing. Low medical and orthopedic complications rates support the safety and good functional outcomes of ATR repair.
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NewsBot · Jan 11, 2026

Endoscopic flexor hallucis longus transfer in the patients with chronic achilles rupture
Hüseyin Kürüm, Adnan Akcan
J Orthop Surg Res. 2026 Jan 10.

Background: achillestendon rupture (ATR) is a widespread tendon injury that can be observed in middle-aged individuals after sporting activities or secondary to trauma. We aimed to retrospectively assess the clinical findings and radiological parameters of individuals treated with isolated endoscopic flexor hallucis longus tendon transfer (FHLT) due to chronic achillestendon ruptures (CATR) before and after surgical intervention. The working hypothesis was that, based on postoperative functional and clinical evaluation, FHLT was an effective and safe method in CATR treatment.

Methods: We analyzed individuals who received an ATR and underwent treatment retrospectively. Individuals who performed isolated FHLT due to CATR were included in the study. Individuals were separated into two main groups: before and after surgical intervention. In addition, grouping was performed according to force arm length and muscle volume. Functional and clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society scores (AOFAS), achillestendon rupture score (ATRS), range of motion degrees, balance performance, data after the heel rise test, force arm length after FHLT, muscle volume, and magnetic resonance imaging (MRI) scans.

Results: The mean degree of dorsiflexion in the extremities on the non-operated side was 23.17 ± 1.63 degrees, while in the extremities on the operated side it was 23.25 ± 1.62 degrees (p = 0.723). Preoperative mean American Orthopedic Foot and Ankle Society scores (AOFAS) and achillestendon rupture score (ATRS) scores were 60.54 ± 6.95 and 48.67 ± 9.21, respectively. Postoperatively, these scores were observed as 87.38 ± 5.44 and 88.92 ± 5.17 (p < 0.001). The mean forward jump distance was 140.58 ± 7.29 centimeters (cm) on the operated side, while it was 147.75 ± 6.42 cm on the non-operated side (p < 0.001). The mean vertical jump distance was 18.67 ± 2.01 cm on the operated side and 21.63 ± 1.01 cm on the non-operated side (p < 0.001). It was observed that there was a good negative statistically significant correlation between plantar flexion (Δ) and the flexor hallucis longus (FHL) force arm length (r=-0.659**).

Conclusions: Endoscopic FHL transfer is a minimally invasive surgical procedure and safe method that restores ankle function to as close to its before-injury state as possible with minimal complications through the correct technical approach, enabling early return to work and sports.
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NewsBot · Jan 13, 2026

Evidence-based clinical practice guidelines on the surgical management of acute Achilles tendon rupture
Shi-Ming Feng et al
Br Med Bull. 2026 Jan 2;157(1):ldaf026.

Background: Surgical intervention remains a cornerstone to restore function after acute Achilles tendon rupture (AATR), but evidence-based guidelines for surgical management are limited.

Sources of data: A steering committee of 40 orthopedic surgeons identified nine key clinical questions on the surgical management of AATR. A systematic search of PubMed, MEDLINE, Web of Science, Cochrane Library, and EMBASE was conducted for studies published since 1980.

Areas of agreement: Surgical management represents a reliable option to manage patients who suffered AATR. A well-designed operative strategy is essential to facilitate early recovery and achieve optimal functional outcomes.

Areas of controversy: The surgical management of AATR remains challenging, particularly with respect to defining surgical indications, determining the optimal timing of intervention, selecting the most appropriate patient positioning, choosing between open and minimally invasive techniques, deciding on the role of primary augmentation, and establishing evidence-based postoperative rehabilitation protocols.

Growing points: In the absence of established guidelines for the surgical management of AATR, this evidence-based clinical practice guideline provides nine key recommendations designed to address current controversies in the field.

Areas timely for developing research: Further studies are warranted to evaluate emerging strategies such as nutraceuticals, biomaterials, cellular therapies, bioprinting, gene therapy, and anti-inflammatory agents, as no single approach has yet been validated as the optimal method to accelerate or enhance recovery following AATR.
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NewsBot · Jan 15, 2026

Outcomes of Non-operatively Managed Achilles
Tendon Rupture: A Retrospective, Single-Centre
Study
Adam Daneshyar , Sajid Ali , Mohanraj Venkatesan , Omar Mostafa , Anam Jawaid , Qutub Qadri ,
Kowshik Jain
Source

Introduction
Achilles tendon ruptures can be managed surgically or conservatively. Due to the increased risk of post-
operative complications, non-surgical management is often preferred. Evidence suggests that non-operative
approaches can achieve outcomes comparable to surgical repair. One such approach is the Leicester Achilles
Management Protocol (LAMP), which involves immobilisation in a VACOped boot for eight weeks. Patient
outcomes following non-operative management are commonly assessed using the Achilles Tendon Total
Rupture Score (ATRS). In this retrospective study, it is hypothesised that patients managed with the LAMP
protocol will report favourable outcomes as measured by the ATRS.
Methodology
This retrospective cohort study analysed patients who presented and were managed for Achilles tendon
rupture at a district general hospital in the West Midlands, UK, between January 2022 and October 2024.
Patients aged 18 years and above with confirmed Achilles tendon injuries (International Classification of
Diseases, Tenth Revision (ICD-10) code: S86.0), managed through fracture or elective clinics, were included
in the analysis. Data obtained from electronic health records included demographics, comorbidities,
management duration, time to rehabilitation, and patient-reported outcomes using the ATRS. ATRS data
were collected via telephone interviews conducted by local clinicians and analysed descriptively using
frequencies, means, and ranges.
Results
A total of 53 patients were initially screened for inclusion. Eight patients were excluded following clinic
reassessment due to misdiagnosis (no rupture or posterior tibial rupture) or death. Of the remaining 45
patients contacted by telephone, 16 did not respond after two attempts, and one declined participation. The
final study cohort comprised 28 patients.
The analysis showed that patients were mainly male, with an average age of 52.1 years (range: 29-82).
Patient-reported outcome measures showed the mean ATRS was 67.1 (range: 26-100), reflecting a wide
variation in self-reported recovery.
Conclusion
Despite a lower ATRS compared to previous studies with non-operative management, this retrospective
study showed that LAMP provides satisfactory functional recovery whilst avoiding operative and post-
operative complications.
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NewsBot · Jan 16, 2026

Evidence-based clinical practice guidelines on the surgical management of acute Achilles tendon rupture
Shi-Ming Feng , et al
British Medical Bulletin, Volume 157, Issue 1, March 2026, ldaf026, https://doi.org/10.1093/bmb/ldaf026

Background

Surgical intervention remains a cornerstone to restore function after acute Achilles tendon rupture (AATR), but evidence-based guidelines for surgical management are limited.
Sources of data

A steering committee of 40 orthopedic surgeons identified nine key clinical questions on the surgical management of AATR. A systematic search of PubMed, MEDLINE, Web of Science, Cochrane Library, and EMBASE was conducted for studies published since 1980.
Areas of agreement

Surgical management represents a reliable option to manage patients who suffered AATR. A well-designed operative strategy is essential to facilitate early recovery and achieve optimal functional outcomes.
Areas of controversy

The surgical management of AATR remains challenging, particularly with respect to defining surgical indications, determining the optimal timing of intervention, selecting the most appropriate patient positioning, choosing between open and minimally invasive techniques, deciding on the role of primary augmentation, and establishing evidence-based postoperative rehabilitation protocols.
Growing points

In the absence of established guidelines for the surgical management of AATR, this evidence-based clinical practice guideline provides nine key recommendations designed to address current controversies in the field.
Areas timely for developing research

Further studies are warranted to evaluate emerging strategies such as nutraceuticals, biomaterials, cellular therapies, bioprinting, gene therapy, and anti-inflammatory agents, as no single approach has yet been validated as the optimal method to accelerate or enhance recovery following AATR.
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NewsBot · Jan 18, 2026

Diagnostic performance of dual-energy Rho/Z CT and cinematic rendering in Achilles tendon rupture: a prospective multi-reader study
Qizheng Wang, Suwei Liu, Yupeng Zhu, Xiaoxi Ji, Yan Zhang, Qiang Zhao, Aihui Di, Yang Lv & Ning Lang
Skeletal Radiology

Objectives

To evaluate the diagnostic performance of dual-energy computed tomography (DECT) Rho/Z mapping and cinematic rendering (CR) for detecting Achilles tendon rupture.
Materials and methods

In this prospective study, 117 consecutive patients (median age, 40 years; IQR, 32.8–44.0; range, 17–62) underwent DECT between January and September 2024. MRI served as the reference for rupture diagnosis and quantitative measures (location and gap). For complex/atypical tears (partial tears, avulsion fractures, intratendinous calcifications), operative findings were used as the reference standard. Three independent readers, blinded to the reference, interpreted images in three sessions (grayscale CT, DECT Rho/Z, and CR) to determine rupture presence, location, and gap. Diagnostic metrics (AUC, sensitivity, specificity, accuracy, PPV/NPV) were calculated; Rho/Z cutoffs were derived by ROC analysis.
Results

In total, 194 DECT/CR datasets were analyzed (77 bilateral = 154; 40 unilateral = 40). DECT Rho/Z and CR outperformed grayscale CT for rupture detection with AUCs > 0.90 (all P < 0.001). Consensus reader accuracy was higher for DECT (94.9%) and CR (91.8%) than for grayscale CT (66.0%). In exploratory subgroup analyses, DECT showed favorable sensitivity and specificity for avulsion fractures and calcifications; for partial tears, DECT/CR achieved high accuracy (99.1%, 116/117). Measurements of rupture location and gap showed substantial agreement with the reference (κ > 0.80). Quantitative parameters (80-keV, Sn150-keV, Rho, Zeff) differed significantly between ruptured and intact tendons (all P < 0.001).
Conclusion

DECT Rho/Z and CR showed strong diagnostic performance versus grayscale CT using MRI/operative findings as references and may provide complementary value in complex cases.
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NewsBot · Jan 24, 2026

Minimally invasive (ring forceps) versus open Achilles tendon repair: A retrospective comparison of ultrasonographic and functional outcomes
Okan Yigit et al
Acta Orthop Traumatol Turc. 2025 Dec 31;59(6):394-404.

Objective: While surgical repair is standard for acute Achilles tendon ruptures, the optimal technique remains debated. This study com pares clinical, functional, and ultrasonographic outcomes between minimally invasive and open surgical approaches, with particular focus on: (1) patient-reported recovery, (2) tendon healing dynamics, and (3) the utility of ultrasound in postoperative monitoring.

Methods: This retrospective study analyzed 108 consecutive patients undergoing surgical repair for acute Achilles tendon ruptures between 2015-2023, comparing minimally invasive (n = 58; ring forceps technique) and open approaches (n = 50; Krackow technique). Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS), Patient-Reported Outcomes Measurement Information System (PROMIS), and Madrid Sonographic Enthesitis Index (MASEI) scores at standardized 6-, 12-, and 24-month follow-ups, while ultrasonographic evaluations quantified tendon thickness at rupture and insertion sites relative to contralat eral tendons. Complication rates and demographic variables were systematically reviewed, with all patients receiving identical postoper ative rehabilitation protocols.

Results: A total of 108 patients were included in the study, with a mean age of 41.56 ± 13.98 years (range, 18-68). Minimally invasive sur gery was performed in 58 patients (53.7%), while the remaining 50 patients (46.3%) underwent open surgical repair. The mean follow-up duration was 2.4 years (minimum of 2 years of follow-up). Patients in the minimally invasive group reported significantly higher PROMIS scores compared to those in the open surgery group (P < .001). However, no significant differences were observed in AOFAS or MASEI scores between the groups (P > .05). Ultrasonographic evaluation revealed that the mean tendon thickness at the rupture site was signifi cantly greater in the minimally invasive group (1.04 cm; range, 0.93-1.15) than in the open surgery group (0.87 cm; range, 0.77-0.93) (P < .001). Furthermore, the operated-to-intact tendon thickness ratio was 2.13 in the minimally invasive group and 1.78 in the open surgery group, which was also statistically significantly different (P = .006).

Conclusion: Minimally invasive achilles tendon repair was associated with potential advantages compared to open techniques, includ ing more favorable patient-reported outcomes (median PROMIS score 80 vs. 76, P < .001), increased tendon thickness (19% greater, P < .001), a potential indicator of differential healing patterns, and lower wound complication rates, while importantly achieving equivalent high-level function as measured by the AOFAS and MASEI scores. The main limitations of this study include its retrospective design and the potential for unmeasured confounding. Ultrasound serves as a critical postoperative tool, objectively quantifying healing progression and informing return-to-sports decisions. These findings suggest potential advantages of minimally invasive approaches and support their consideration as a viable alternative to open repair in selected patients; however, the choice of technique should be individualized based on surgeon experience and patient-specific factors. However, these associative findings require validation in randomized trials.
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NewsBot · Jan 25, 2026

Structure and function of the Achilles tendon and plantarflexors after non-surgical management of Achilles tendon rupture: a 12-month cohort study
Source

Introduction Achilles tendon rupture’s (ATR) are increasing globally and are commonly managed non-surgically. We aimed to understand recovery using ultrasound imaging, strength testing and patient reported outcomes.

Materials and Methods Longitudinal cohort study consisting of 60 participants post-ATR managed non-surgically. Assessments were performed at week 0, 8, 10, 16, 26, and 52. Outcomes included Ultrasound Tissue Characterisation (UTC): Cross-Sectional Area (CSA) of Aligned Fibrillar Structure (AFS) and Disorganised Fibrillar Structure (DFS). Plantarflexor strength was measured using maximal voluntary isometric contraction (MVIC) and the calf raise test. Patient-reported outcomes included the Achilles Tendon Rupture Score (ATRS), EQ-5D-5L and Tampa Scale for Kinesiophobia (TSK). Achilles tendon resting angle (ATRA) indirectly measured tendon elongation.

Results Thirty-six participants completed 52 week follow up (mean age 49 years, 85% male, body mass index 30). Primary ATR mechanism was sport (75%)

At all assessments, the ruptured tendon CSA and DFS was significantly greater than the non-ruptured side (p<0.001). At 52 weeks, DFS represented 28% of the ruptured tendon in comparison to 14% on the non-ruptured side.

MVIC on the ruptured limb at 52 weeks was 93kg or 1xbody weight (BW) and non-ruptured limb was 127kg or 1.4xBW. Leg symmetry index (LSI) at 12 months was 73%. Calf raise test LSI at 52 weeks was 60%. Relative ATRA was 7°.

ATRS at 52 weeks was 77, EQ-5D-5L index 0.9, EQ-5D-5L VAS 80, TSK 35.

Conclusion At 52 weeks following non-surgical management of ATR there was persistent fibrillar disorganisation, isometric plantarflexor weakness, tendon elongation and reduced function.
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NewsBot · Jan 29, 2026

Role of pre-existing pathological changes in postoperative function and tendon elasticity after Achilles tendon rupture repair
a retrospective cohort study
Lu Bai et al
SOurce

Aims

Achilles tendon rupture is usually caused by mechanical forces and internal pathological changes, but the association of these changes with postoperative outcomes has not been well established. This study aims to explore the relationship between different pathological types of Achilles tendon rupture and postoperative function, tendon elasticity, and structural thickening.
Methods

This retrospective cohort study included patients who underwent Achilles tendon rupture surgery from May 2017 to May 2021. Pathological types were classified using haematoxylin and eosin staining as normal, mucoid degeneration, degeneration, fatty infiltration, or calcification. The outcomes, including functional scale, tendon elasticity, and thickening, were compared between the pathological types and normal tendons. Univariate and multivariable linear regression, along with mixed-effects models, were used to analyze the association between pathological types and postoperative outcomes.
Results

Among 165 patients, 46 (27.8%) were normal, 21 (12.7%) had mucoid degeneration, 22 (13.3%) had fatty infiltration, 36 (21.8%) had calcification, and 40 (24.2%) had degeneration. Functional outcomes showed no significant differences in trends over the follow-up time in different tendon pathology types compared to the normal group. At one year, the mucoid group showed 0.14 m/s elongated tendon elasticity in plantarflexion (95% CI -0.24 to -0.04; p = 0.006) and 0.94 m/s decreased dorsiflexion (95% CI -1.59 to -0.04; p = 0.007), with similar results at two years (95% CI -1.11 to -0.21; p = 0.006). Fatty infiltration showed 0.14 m/s elongated dorsiflexion elasticity ( 95% CI -1.09 to -0.19, p = 0.006). The calcified group had 0.68 mm decreased diameter at two years (95% CI -1.20 to -0.26; p = 0.002).
Conclusion

Mucoid degeneration and fatty infiltration are linked to alterations in tendon elasticity. Calcification is associated with a reduction in tendon diameter over time. The pathological features may not substantially impact long-term functional recovery.
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NewsBot · Feb 6, 2026

A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative
João Vide et al
Knee Surg Sports Traumatol Arthrosc. 2026 Feb 6.

Purpose: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

Methods: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

Results: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

Conclusion: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.
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NewsBot · Feb 10, 2026

A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative
João Vide, Francisco Santos, Sofia Dantas, Emanuel Seiça, João Caetano, Daniel Mendes, Manuel Resende Sousa, Mette Anderson, Matteo Guelfi, Choon Chiet Hong … See all authors
Source

Purpose

Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.
Methods

A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A ‘main tendency’ was considered when 75% of the participants chose the same treatment method, a ‘tendency’ for 50%–75%, and ‘no tendency’ when less than 50% choose the same method.
Results

A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4–6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).
Conclusion

This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.
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NewsBot · Feb 12, 2026 at 11:38 PM

Achilles Tendon Repairs in Adolescent and Young Adult Athletes <25 Years Old: A Retrospective Multicenter Case Series
Dennis E Kramer et al
Orthop J Sports Med. 2026 Feb 9;14(2):23259671251413268.

Background: The outcomes of Achilles tendon tears have been minimally investigated in adolescents and young adults, with sparse literature-based evidence to guide management.

Purpose/hypothesis: The purpose of this study was to describe the demographics, presentation, treatment, complications, and long-term functional follow-up including patient-reported outcomes (PROs), and return-to-sport (RTS) rates of adolescent and young adult athletes with Achilles tendon ruptures. It was hypothesized that despite high activity demands, perioperative complication rates would be low and RTS rates high.

Study design: Case series; Level of evidence, 4.

Methods: Records were reviewed of all patients aged <25 years treated at 1 of 2 pediatric tertiary care centers for an Achilles tendon tear or laceration between 2004 and 2018. Demographics, imaging, treatment, and clinical follow-up data were retrospectively collected. Patients ultimately managed without surgery were rare and excluded. Patients with >1 year of clinical follow-up or those who responded to prospective patient outreach for PRO collection were investigated for clinical outcomes, utilizing the Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale (TAS), and questions about reinjury and RTS.

Results: Of the 38 patients identified, 24 (63%; mean age, 18.9 years; range, 10.4-22.8 years; 42% male) were analyzed for clinical outcomes. A total of 22 patients (92%) had complete tears, 2 had partial tears. Twenty patients (83%) returned questionnaires at a median 6.3 years (IQR, 3.4-9.7 years) while the other 4 patients were seen in clinic at a median of 1.2 years (IQR, 1.0-1.8 years) following injury. The median postoperative ATRS score was 96 (IQR, 82-100) and median TAS score was 6 (IQR, 4-8). Median FAOS scores were excellent for symptoms (91), pain (100), activities of daily living (100), and sports (98) and good for quality of life (88). The 6-month RTS probability was 47% (95% CI, 19%-66%) and at 12 months was 95%. The median time to RTS for partial tears was 5.6 months versus 6.6 months for complete tears (P = .05). Seven patients (29%) experienced a perioperative complication including 3 cases of delayed wound healing (13%) and 1 tendon retear (4%), which underwent revision repair.

Conclusion: Adolescent and young adult athletes surgically treated for high-grade Achilles injuries had favorable long-term outcomes, low rerupture rates, and median RTS timing (~6 months) similar to that reported in adult studies.
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NewsBot · Feb 13, 2026 at 12:11 AM

Structure and Function of the Achilles Tendon and Plantarflexors 1 Year Following Achilles Tendon Rupture in the United Kingdom: A Cross-Sectional Study
Samuel Briggs-Price et al
J Foot Ankle Res. 2026 Mar;19(1):e70134.

Background: Achilles tendon rupture (ATR) is the most common tendon rupture affecting the lower limb. This study investigates Achilles tendon structure, strength and function 1 year or more after ATR.

Methods: This cross-sectional study recruited individuals ≥ 12 months post ATR. Structure was assessed using ultrasound tissue characterisation (UTC) including cross-sectional area (CSA), aligned fibrillar structure (AFS), disorganised fibrillar structure (DFS) and echo type percentage. Strength was measured using maximal voluntary isometric contraction (MVIC) plantarflexor testing and the calf raise test. Patient-reported outcomes included the Achilles tendon rupture score (ATRS), EQ-5D-5L and general practice physical activity questionnaire (GPPAQ). Achilles tendon resting angle (ATRA) was used as an indirect measure of tendon elongation. The relationship between outcomes and time since ATR was analysed using linear regression adjusting for age, sex, ethnicity and body mass index (BMI). Between limb comparisons were made using paired t-tests.

Findings: Sixty participants (mean age 55.2 years and 78.5% male) were assessed at a mean of 6.8 years post ATR. The affected tendon showed a 62% larger cross-sectional area, with 28.7 mm2 (16%) DFS compared to 7.3 mm2 (7%) on the nonaffected side (p < 0.001). Linear regression showed decreasing AFS with time postinjury (p = 0.04); no significant associations were found for CSA or DFS. Significant deficits were observed in plantarflexor strength and function, with MVIC and calf raise work 18% and 40% lower in the affected limb (p < 0.001). ATRA indicated tendon elongation in the affected limb of 6.7° (p < 0.001). Median ATRS was 83, EQ-5D index was 0.95 and VAS was 85; 93% were physically active based on the GPPAQ.

Conclusion: Significant structural and functional deficits persist years after ATR, including increased tendon size, fibre disorganisation, reduced strength and tendon elongation. ATRS scores were consistent with previous nonsurgical immobilisation protocol outcomes in the United Kingdom. Longitudinal studies are needed to understand the trajectory of recovery following ATR.
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Achilles tendon rupture

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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 Tendonitis Relief From Heel Lifts

Relief and Recovery: How Atlas Biomechanics Cork Heel Lifts Treat Achilles Tendonitis

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

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