Achilles tendon rupture

NewsBot · Aug 9, 2023

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

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

Design:
Prospective observational cohort study.

Setting:
University hospital foot and ankle clinic.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusions: MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.
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NewsBot · Oct 5, 2023

Long-term outcome of flexor hallucis longus tendon transfer for chronic Achilles tendon rupture with large defect: A retrospective series.
Xu Y et al
Medicine, 01 Sep 2023, 102(39):e35302

There are multiple surgical options for treatment of chronic Achilles tendon (AT) rupture according to the classifications and length of defect. However, no gold standard method has been confirmed, and there is no clear evidence to support the superiority of 1 procedure over others. This study aimed to evaluate the long-term clinical outcome of flexor hallucis longus tendon (FHL) transfer for chronic AT rupture with large defect. Clinical data of patients treated with FHL transfer due to chronic AT rupture between January 2009 and October 2019 were reviewed retrospectively. All cases were presented with AT rupture for more than 4 weeks after injury. The gap between ruptured ends was > 5 cm after debridement in all patients. The harvest of FHL was performed through a single incision in accordance with AT rupture debridement in all cases. Clinical outcomes were assessed with AOFAS ankle-hindfoot scale, Achilles tendon total rupture score and AOFAS hallux metatarsophalangeal-interphalangeal scale. Twenty-eight patients were followed successfully for 62.6 ± 22.2 months. According to the complete datasets obtained from 28 patients, none of the tendons re-ruptured. The AOFAS ankle-hindfoot scale and Achilles tendon total rupture score at last follow-up visit was 90.4 ± 5.7 and 89.8 ± 5.3 respectively, which revealed statistically significant improvement from the preoperative score of 61.1 ± 6.7 and 53.8 ± 8.3. The AOFAS hallux metatarsophalangeal-interphalangeal scale at last follow-up visit was 87.5 ± 6.1. The FHL transfer through a single incision for chronic AT rupture with large defect is a safe and simple method with low risk of morbidity and complications.
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NewsBot · Oct 10, 2023

Surgical Management of Chronic Achilles
Tendon Ruptures: A Systematic Review
and Proposed Treatment Algorithm
Mohammad T. Azam, et al
Foot & Ankle Orthopaedics

Background: As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic
review of the literature was performed to compare the different treatment options and recommend a literature-based
algorithm.
Methods: In June 2022, MEDLINE, Embase, and Cochrane Library databases were systematically reviewed based on the
PRISMA guidelines. The level of evidence (LOE) and quality of evidence were evaluated, and statistics on clinical outcomes
and complications were calculated.
Results: Twenty-seven studies with 614 patients were included. Three studies were LOE III and 25 studies were
LOE IV. The mean Achilles tendon rupture score improved from a preoperative weighted mean of 38.8 ± 12.4 to a
postoperative score 90.6 ± 4.7. The overall complication rate was 11.4%. Single techniques were used in 23 studies
and dual techniques were used in 5 studies. The FHL tendon transfer was the most frequently used technique. We
devised an algorithmic approach based on time from injury to surgical intervention and the length of the gap between
the tendon stumps: >3 months: FHL transfer; <3 months (a) gap <2 cm, end-to-end repair; (b) gap 2 to 5 cm,
gastrocnemius transfer, (c) gap >5 cm, semitendinosus autograft.
Conclusion: Surgical management of CATR produced improvements in patient-reported outcome scores at midterm
follow up, but a high complication rate (11.4%) was noted. Our proposed treatment algorithm may assist in shared decision
making for this complex problem.
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NewsBot · Oct 10, 2023

Use of point-of-care ultrasound in a low-resource setting to diagnose Achilles tendon rupture and avulsion fracture of the calcaneal bone
Naheed Habibullah, Jamil Dayo, Salman Muhammad Soomar & Noman Ali
International Journal of Emergency Medicine volume 16, Article number: 66 (2023)

Background
Point-of-care ultrasound (POCUS) is becoming more prevalent in recent years for evaluating patients presenting with musculoskeletal injuries in the emergency department (ED). This imaging modality has been utilized to diagnose soft tissue and bony injuries accurately, obtain appropriate consultation, and perform timely interventional procedures in the ED.

Case presentation
We present the case of a 55-year-old man who presented to the ED with significant left ankle pain following a ground-level fall. His physical examination showed swelling and tenderness around the ankle. POCUS examination aided the rapid and accurate detection of acute Achilles tendon rupture.

Conclusion
This case demonstrates that POCUS is a valuable diagnostic tool in evaluating patients with a suspected Achilles tendon rupture, especially in a resource-limited setting.
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NewsBot · Oct 16, 2023

Acute Achilles Tendon Ruptures Treated With Endoscopic Flexor Hallucis Longus Transfer
Michail Kotsapas M.D., M.Sc. et al
Arthroscopy Techniques; 11 October 2023

The Achilles tendon represents the most commonly ruptured tendon of the human body. Numerous studies have evaluated, throughout the years, management options regarding acute Achilles tendon rupture. Minimally invasive techniques have recently gained more popularity. Endoscopic flexor hallucis longus tendon transfer has been mainly described as a treatment method for neglected Achilles tendon ruptures. However, it has recently been described as an applicable treatment option for acute Achilles tendon ruptures as well. Nevertheless, this procedure is technically quite demanding and should be performed by experienced surgeons. This technical note thoroughly describes the endoscopic flexor hallucis longus transfer technique for acute Achilles tendon ruptures, focusing on the most important technical aspects, thus attempting to simplify and render this procedure more widely accepted.
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NewsBot · Oct 23, 2023

Return-to-performance in elite soccer players after Achilles tendon ruptures: a study using a weighted plus/minus metric and matched-control analysis
Pedro Diniz, Diogo Lacerda, Bruno Mendes, Hélder Pereira, Frederico Castelo Ferreira & Gino M. M. J. Kerkhoffs
Source

Purpose
Studies have shown decreased match participation and shortened careers in athletes suffering Achilles tendon ruptures (ATRs), but assessment using a true performance metric is lacking. Plus/minus (PM) metrics provide a practical and objective approach to player performance assessment and are commonly used in other sports. This study aimed to quantify and compare individual player performance variations in elite football league players who sustained ATRs and returned to play within 1 year compared to those without ATRs, using a PM metric.

Methods
Player and team data were sourced from Transfermarkt.com. Male players sustaining ATRs between 2007 and 2018 were identified through injury reports. A control group (CTRL) was matched by position, age, height, and league, with a 6:1 ratio of controls to ATR subjects. The day of injury was considered “time zero”. Year -1 corresponds to the 360 days preceding injury, and Year 1 to the interval between 360 and 720 days after. Performance in the player’s main team was evaluated using a previously validated weighted PM metric. Only data from Year -1 and Year 1 were used for ATR versus CTRL group comparisons. Statistical significance was set at p < 0.05.

Results
The ATR group included 125 athletes. Data from more than 76,000 matches were analyzed. No statistically significant differences in net weighted PM metric between Year -1 and Year 1 were found.

Conclusion
No differences were found between athletes suffering from ATRs and controls regarding the weighted PM metric.
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NewsBot · Oct 24, 2023

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis
Ihsan Oesman, Anissa Feby Canintika
Foot Ankle Orthop. 2023 Oct 15;8

Background: Nonabsorbable sutures are still the main choice for acute Achilles tendon rupture (AATR) repair due to strength provided. However, the rerupture rates, infection risks, foreign body reaction, and postsurgical recovery differences between absorbable and nonabsorbable suture materials in AATR repair have not been carefully reviewed.

Methods: A systematic review was done on PubMed, EBSCO, Cochrane Central Register of Controlled Trials, and Embase to find research studies in relation to complications associated with AATR repair using the PRISMA guidelines. The risk of bias from each study included will be assessed using the Cochrane Risk of Bias Tool for randomized study (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) for nonrandomized study.

Results: Five studies with a total of 255 patients, 105 in the absorbable suture group and 150 in the nonabsorbable suture group, were included for analysis. Risk of rerupture, infection, and foreign body reaction shown no significant difference between groups, and the mean difference of recovery scores were similar.

Conclusion: Existing literature shows that absorbable sutures appear to be associated with similar outcomes to nonabsorbable sutures regarding rates of rerupture, infection, foreign body reaction, and outcomes grading following surgical repair of acute Achilles tendon repair.
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NewsBot · Oct 25, 2023

Differential elongation of the gastrocnemius after Achilles tendon rupture: a novel technique of selective shortening to treat push-off weakness with case series and literature review
Choon Chiet Hong et al
Knee Surg Sports Traumatol Arthrosc. 2023 Oct 14

Purpose: Differential elongation of the gastrocnemius after Achilles tendon rupture (ATR) may compromise the ability of athletes to return to competition. Recognition of this differential elongation of the gastrocnemius relative to the soleus is vital to treat patients with weakness in push-off. This paper describes a novel technique performed for selective shortening of the gastrocnemius to treat push-off weakness.

Methods: Three patients with differential proximal retraction of the gastrocnemius greater than 20 mm after treatment for ATR with inability to run and jump underwent surgical correction with this novel technique and were followed-up for 2 years. A novel selective shortening of the gastrocnemius with autologous hamstring graft was performed in these patients. The Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up.

Results: All three patients were able to return to running and jumping at final follow-up. The ATRS improved significantly in the strength, fatigue, running and jumping domains but there appeared to be a less notable improvement in activities of daily living domain. The AOFAS score showed improvement with the greatest margin in the domain of activity limitation.

Conclusion: This procedure is the first described selective shortening method of the gastrocnemius tendons after differential elongation following ATR. It is a safe and reliable technique providing improved ATRS and AOFAS scores in three patients who were all able to return to running and jumping sports at 2-year follow-up.
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NewsBot · Oct 30, 2023

Surgical Setting in Achilles Tendon
Repair: How Does It Relate to Costs and
Complications?
Rachel S. Bronheim, et al
Foot & Ankle Orthopaedics 2023, Vol. 8(4) 1–7

Background: Primary Achilles tendon repair (ATR) can be performed in ambulatory surgery centers (ASCs) or hospitals.
We compared costs and complication rates of ATR performed in these settings.
Methods: We retrospectively queried the electronic medical record of our academic health system and identified 97
adults who underwent primary ATR from 2015 to 2021. Variables were compared between patients treated at ASCs vs
those treated in hospitals. We compared continuous variables with Wilcoxon rank-sum tests and categorical variables with
χ2
tests. We used an α of 0.05. Multivariable logistic regression was performed to determine associations between surgical
setting and costs. Linear regression was performed between each charge subtype and total cost to identify which charge
subtypes were most associated with total cost.
Results: Patients who underwent ATR in hospitals had a higher rate of unanticipated postoperative hospital admission
(13%) than those treated in ASCs (0%) (P=.01). We found no differences with regard to postoperative complications,
emergency department visits, readmission, rerupture, reoperation/revision, or death. Patients treated in hospitals had
a higher mean (±SD) implant cost ($664±$810) than those treated in ASCs ($175±$585) (P<.01). We found no
differences between settings with regard to total cost, supply costs, operating room charges, or anesthesia charges. Higher
implant cost was associated with hospital setting (odds ratio=16 [95% CI: 1.7-157]) and body mass index>25 (odds
ratio=1.2 [95% CI: 1.0-1.5]). Operating room costs were strongly correlated with total costs (R2=.94).
Conclusion: The overall cost and complication rate of ATRs were not significantly different between ASCs and hospitals.
ATRs performed in hospitals had higher implant costs and higher rates of postoperative admission than those performed
in ASCs.
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NewsBot · Oct 31, 2023

Nicotine Dependence and Rates of Postoperative Complications in Achilles Tendon Repair
Sterling DeShazo et al
Foot Ankle Int. 2023 Oct 30

Background: Nicotine is a modifiable risk factor that is well demonstrated to cause deleterious effects on tendon healing and overall health. Individuals that have a dependence on nicotine may be at an elevated risk for numerous postoperative complications when compared to nondependent patients. The purpose of this study is to evaluate the complications postoperatively between nicotine- and non-nicotine-dependent Achilles tendon repairs.

Methods: The global health network database, TriNetX, was used to access and analyze deidentified patient information. Two cohorts were identified for the purposes of this study. Cohort A was defined as patients who had an Achilles tendon repair (Current Procedural Terminology [CPT]: 27650 or CPT: 27654) and had a dependence to nicotine (International Classification of Diseases, Tenth Revision, code: F17). Cohort B was defined as patients who had an Achilles tendon repair but did not have a dependence to nicotine. Data were gathered from health care organizations from August 21, 2000, to August 21, 2023. All postoperative complications were analyzed between 1 and 90 days after the Achilles tendon repair.

Results: A total of 2117 nicotine-dependent patients were matched with 18 102 non-nicotine-dependent patients. After propensity matching for age at event, ethnicity, race, sex, and type 2 diabetes mellitus, nicotine-dependent patients who underwent Achilles tendon repair experienced higher associated risk for numerous postoperative complications. When compared to nondependent patients, nicotine-dependent patients had increased risk for wound disruption (risk ratio [RR] 1.55, 95% CI 1.11-2.16) and infection following a procedure (RR 1.64, 95% CI 1.09-2.47) within 90 days post Achilles tendon repair.

Conclusion: In this database study using propensity matching, nicotine-dependent patients who underwent Achilles tendon repair were correlated with an increased associated risk for wound disruption and infection after a procedure than their non-nicotine-dependent counterpart
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NewsBot · Nov 2, 2023

Surgical Setting in Achilles Tendon Repair: How Does It Relate to Costs and Complications?
Rachel S Bronheim et al
Foot Ankle Orthop. 2023 Oct 24;8(4)

Background: Primary Achilles tendon repair (ATR) can be performed in ambulatory surgery centers (ASCs) or hospitals. We compared costs and complication rates of ATR performed in these settings.

Methods: We retrospectively queried the electronic medical record of our academic health system and identified 97 adults who underwent primary ATR from 2015 to 2021. Variables were compared between patients treated at ASCs vs those treated in hospitals. We compared continuous variables with Wilcoxon rank-sum tests and categorical variables with χ2 tests. We used an α of 0.05. Multivariable logistic regression was performed to determine associations between surgical setting and costs. Linear regression was performed between each charge subtype and total cost to identify which charge subtypes were most associated with total cost.

Results: Patients who underwent ATR in hospitals had a higher rate of unanticipated postoperative hospital admission (13%) than those treated in ASCs (0%) (P = .01). We found no differences with regard to postoperative complications, emergency department visits, readmission, rerupture, reoperation/revision, or death. Patients treated in hospitals had a higher mean (±SD) implant cost ($664 ± $810) than those treated in ASCs ($175 ± $585) (P < .01). We found no differences between settings with regard to total cost, supply costs, operating room charges, or anesthesia charges. Higher implant cost was associated with hospital setting (odds ratio = 16 [95% CI: 1.7-157]) and body mass index > 25 (odds ratio = 1.2 [95% CI: 1.0-1.5]). Operating room costs were strongly correlated with total costs (R2 = .94).

Conclusion: The overall cost and complication rate of ATRs were not significantly different between ASCs and hospitals. ATRs performed in hospitals had higher implant costs and higher rates of postoperative admission than those performed in ASCs.
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NewsBot · Nov 9, 2023

Shear Wave Tensiometry Can Detect Loading Differences Between Operated and Unaffected Achilles Tendon
Alessandro Schneebeli et al
Foot Ankle Int. 2023 Nov 4:

Background: The clinically relevant healing process of a ruptured and repaired Achilles tendon (AT) can last more than a year. 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 rupture versus 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 ultrasonographic imaging.

Methods: Twenty-one patients with surgically treated AT ruptures were investigated 12-37 months after surgery. Tendon load was measured using a shear wave tensiometer composed of an array of 4 accelerometers fixed on the tendon. Shear wave speed along the Achilles tendon was evaluated at different levels of ankle torque for both the operated and the unaffected side. Mechanical properties of the tendons were evaluated using MyotonPRO and morphological properties using ultrasonographic imaging. Friedman test was used to assess differences in AT wave speed, stiffness, thickness, and cross-sectional area between the operated and the unaffected tendon.

Results: We found a significant shear wave speed difference between sides at every ankle joint torque (P < .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 remained significantly higher compared to the unaffected side.

Conclusion: In this cohort, we found that shear wave tensiometry can 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 morphologic properties, remains higher for 1-3 years after a rupture.
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NewsBot · Nov 13, 2023

Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study
Chen-Xi Wu et al
Chin J Traumatol. 2023 Oct 27

Purpose: Previous studies have confirmed that Achilles tendon undergoes Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between its elasticity and postoperative function.

Methods: In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference.

Results: AOFAS and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period.

Conclusion: Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.
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NewsBot · Nov 27, 2023

Quantitative Assessment of Calf Muscle Volume, Strength, and Quality After Achilles Tendon Rupture Repair: A 1-Year Prospective Follow-up Study
Shota Mashimo et al
Source

Background:
A number of studies have reported that calf muscle atrophy is a common long-term problem after Achilles tendon repair; however, there is still a lack of data concerning early postoperative morphological changes in the calf muscle after surgery.
Purpose:
To investigate changes over time in calf muscle volume and fatty degeneration during 1 year after Achilles tendon repair.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
A prospective 1-year serial magnetic resonance imaging study was carried out with 20 patients who underwent tendon repair for unilateral acute Achilles tendon rupture. The magnetic resonance imaging assessment in addition to clinical and functional evaluations was performed at 1, 3, 6, and 12 months after surgery. The muscle volume of the medial and lateral gastrocnemius, soleus, and flexor hallucis longus (FHL) and fatty degeneration of the medial and lateral gastrocnemius and soleus were measured for the calf muscles, and the relative volume and fatty degeneration changes in the affected leg compared with the healthy contralateral leg were calculated as a percentage ([injured/healthy control] × 100) to assess structural changes over time.
Results:
Muscle volumes of the medial gastrocnemius, lateral gastrocnemius, soleus, and FHL were 92.3%, 92.8%, 84.6%, and 95.9% at 12 months after surgery, respectively. Medial and lateral gastrocnemius and FHL muscle volumes improved over time and recovered to almost equal to that of the healthy side at 12 months after surgery. The soleus muscle volume did not recover significantly over time and was statistically significantly smaller than that of the healthy side at 12 months (P = .029). Fatty degeneration rates of the medial gastrocnemius, lateral gastrocnemius, and soleus were 118.2%, 113.9% and 121.1% at 12 months after surgery, respectively. Fatty degeneration of the medial and lateral gastrocnemius did not change significantly, but there was a statistically significant increase in fatty degeneration of the soleus over time (P < .001).
Conclusion:
Within the triceps surae muscle, the soleus was the most negatively affected by injury and repair for both muscle volume and fatty degeneration. Postoperative management to recover the soleus muscle function before a return to sporting activities should be considered in the future.
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NewsBot · Dec 11, 2023

A Segmental Rupture of Achilles Tendon, its Management, and Outcome - A Rare Case Report
Soutrik Mukherjee, Kallol Banerjee
J Orthop Case Rep. 2023 Nov;13(11):53-57

Introduction: Achilles tendon is the thickest and strongest tendon of the body, spanning from the middle of the calf up to its insertion into the calcaneal tuberosity, and it is estimated to be the third most frequent tendon to rupture. Segmental Achilles tendon rupture, however, is a very rare occurrence and it comes with challenges of salvaging the tendon segment, preventing necrosis of the overlying skin, preventing infection, and preserving the repaired construct to regain good functional outcome. We present a rare case of an acute traumatic segmental rupture of Achilles tendon in a young male, its management and outcome.

Case report: A 25-year-old male suffered a direct blow to the posterior aspect of his left ankle above the heel and presented to us on the same day. On examination, a lacerated wound with visible ruptured ends of the tendon was found. A palpable gap was also felt over a proximal sutured wound and a real-time ultrasonography revealed a complete tear of Achilles tendon in the proximal site as well. Both the wounds were explored and a segmental Achilles tendon rupture was found. A dual level Krackow's suturing was done with augmentation of the distal repair with anchorage in the calcaneus. Following a stringent post-operative rehabilitation, the patient was allowed weight-bearing from 12 weeks onward. At 6-month follow-up, the tendon continuity was intact both clinically and radiologically, and the patient was able to ambulate bearing full weight having bilaterally comparable ankle range of motion.

Conclusion: Rupture of Achilles tendon is relatively common; however, a segmental rupture of the tendon is very rare and poses a challenge for optimum management. Awareness about the possible complications and addressing them with a timely intervention followed by a well-balanced rehabilitation can salvage the tendon and yield good results.
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NewsBot · Dec 17, 2023

Evaluation for Achilles tendon rupture based on Mueller matrix polarimetry
Huibin Yang, Minhui Xu, Nan Zeng, and Hui Ma
Proc. SPIE 12770, Optics in Health Care and Biomedical Optics XIII, 1277029 (27 November 2023); https://doi.org/10.1117/12.2687047

Achilles tendon rupture has become an important problem with the increasing incidence in recent years. At the same time, there are many methods for the treatment of Achilles tendon rupture. How to statistically assess the severity of Achilles tendon rupture is significant for judging the effectiveness of the treatment methods. There are many methods to evaluate the severity of Achilles tendon rupture in clinical practice, most of which are invasive or require staining, which is relatively cumbersome. Because of its sensitivity to microstructures, particularly anisotropy analysis in disease diagnosis, Mueller matrix polarimetry has shown promise as a label-free technique in biomedical research. Therefore, Mueller matrix polarimetry is used to evaluate the severity of the Achilles tendon rupture. The results show that Muller matrix parameters could distinguish the normal Achilles tendon samples from the injured Achilles tendon samples and could distinguish trends in the internal composition of the Achilles tendon. We provide a non-contact and non-labeling in situ method for the assessment of Achilles tendon rupture, which is very promising.
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NewsBot · Dec 17, 2023

Portable device for measuring isometric plantar-flexion force after open Achilles repair: Retrospective cohort of 30 recreational athletes with one-year minimum follow-up
Marc Saab et al
Orthop Traumatol Surg Res. 2023 Dec 10

Background: Plantar flexion force in recreational athletes after repair of Achilles tendon tears has rarely been reported, due to the lack of a widely available and fast measurement method. Knowledge of this parameter would allow optimisation of muscular and sports recovery. The main objective of this study was to measure the isometric force of the triceps surae at least 1 year after unilateral Achilles-tendon repair, comparatively to the unaffected side, using a portable device. The secondary objectives were to compare Achilles tendon and calf-muscle trophicity, dorsiflexion, and the single-leg heel-rise test versus the normal side and to assess functional scores at last follow-up.

Hypotheses: (i) Plantar flexion force does not differ significantly between the operated and contralateral sides. (ii) Calf-muscle trophicity, dorsiflexion, and the single-leg heel-rise test do not differ significantly between the operated and contralateral sides.

Patients and methods: This single-centre retrospective study included patients aged 18 to 65 years with a history of open repair of an acute unilateral Achilles tear at least 1 year earlier. Plantar flexion force, calf-muscle trophicity, dorsiflexion, and the heel-to-floor distance were measured on both sides and compared. The ATRS, VISA-A score, and EFAS score were determined. All complications were recorded.

Results: The study included 30 patients with a mean follow-up of 20.3 months (range, 12-28 months). The operated side had significantly lower values for isometric triceps surae force, calf circumference, and heel-to-floor distance compared to the contralateral side (p<0.0001). Tendon width was significantly greater on the operated side (p<0.0001). Dorsiflexion did not differ significantly between sides (p=0.106). Mean functional score values were 91.5±6 for the ATRS (maximum, 100), 85±12 for the VISA-A score (maximum, 100), and 19.5±4 for the EFAS score (maximum, 24).

Discussion: Isometric triceps-surae force measured using a portable device at least 1 year after open surgical Achilles-tendon repair was significantly decreased compared to the contralateral side. Calf circumference and heel-to-floor distance were also significantly lower. These data indicate a need for improved monitoring of triceps surae recovery to optimise rehabilitation and sports resumption.
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NewsBot · Dec 18, 2023

Flexor Hallucis Longus Transfer And V-Y Plasty: An Effective Treatment Modality for Chronic Achilles Rupture - A Case Series
R H Rashid et al
Malays Orthop J. 2023 Nov;17(3):59-65

Introduction: To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy.

Materials and methods: A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score.

Results: Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the six-month follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011).

Conclusion: FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.
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NewsBot · Dec 26, 2023

Acute Achilles tendon rupture: modern management
Mona Theodoraki, Victoria Sinclair
Orthopaedics and Trauma; 21 December 2023

Achilles tendon rupture is a common injury and its incidence is increasing. There is a large body of literature on the subject and much of it debates the influence of management on re-rupture rates. Operative treatment was thought to be superior in reducing the risk of re-rupture. However, it must be balanced against the risks, in particularly wound infection and breakdown, and sural nerve injury. Minimally invasive surgery aimed to reduce wound complications but has frequently been associated with a higher risk of sural nerve damage and irritation. The introduction of functional rehabilitation, which includes early weight bearing and range of motion within an orthosis, has been pivotal in improving outcomes particularly in non-operatively managed patients. More recent evidence suggests that re-rupture rates are now similar between operatively and non-operatively managed patients when incorporating a functional rehabilitation protocol. The publication of the Achilles Tendon Rupture Score, which has been validated specifically for this injury, has been helpful in providing a more detailed picture of post-injury symptoms and function. The studies which have included this as an outcome measure have also shown comparable results between operatively and non-operatively treated patients.
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NewsBot · Dec 26, 2023

Conservative treatment outcome for Achilles tendon re-rupture occurring in the subacute phase after primary repair
Jun Young Choi, Suk Kyu Choo, Byung Ho Kim & Jin Soo Suh
Archives of Orthopaedic and Trauma Surgery

Introduction
Until now, a treatment protocol for Achilles tendon re-rupture (ATRR) occurring in the postoperative period 5–12 weeks following primary Achilles tendon repair has not been established. We refer to this time frame as the subacute postoperative phase, and the objective of this study was to assess the efficacy of conservative treatment for subacute ATRR in this phase.

Materials and methods
We conducted a retrospective review of 390 cases (385 patients) who had undergone primary Achilles tendon repair using the 4-strand Krachow method between January 2010 and August 2021. All patients were subjected to more than 12 months of follow-up and were categorized into two groups based on the presence of subacute ATRR: Group 1 comprised 370 cases without ATRR, while Group 2 comprised 20 cases with ATRR. Following confirmation of ATRR, we immediately applied a below-knee cast in an ankle plantar flexed position (25°–30°), followed by bracing according to the same rehabilitation plan used for the primary repair. After administering conservative treatment to the patients with ATRR, we compared several outcome parameters between the two groups, including isokinetic plantar flexion power measured using a dynamometer, time required for a single heel raise (t-SHR), time needed for ten repetitive SHRs (t-SHR10), Achilles Tendon Total Rupture Score (ATRS), and Foot and Ankle Ability Measure (FAAM) scores. The baseline timepoints for Groups 1 and 2 were the dates of the primary repair and the re-injury event.

Results
After primary Achilles tendon repair, subacute ATRR occurred in 5.1% of patients. There were no significant differences between the groups in terms of t-SHR and t-SHR10 (P = 0.281, 0.486). Similarly, the isokinetic dynamometer measurements revealed no significant differences in peak torque for plantar flexion at angular velocities of 30°/s and 120°/s, both in absolute values and as a percentage of the contralateral side, between the groups (P > 0.05 for each). However, ATRSs were significantly lower in Group 2 compared to Group 1 before 6 months (P < 0.05), as were FAAM-Activities of Daily Living scores at 6 months (P < 0.05). After 12 months, there were no significant differences in these scores between the two groups (both P > 0.05).

Conclusion
Conservative treatment for subacute ATRR following primary Achilles tendon repair yields clinical outcomes comparable to those without ATRR. Therefore, we recommend that surgeons consider relying on the patient’s natural healing capabilities rather than opting for aggressive surgical interventions, as expediting such operations may be unnecessary for subacute injuries.
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NewsBot · Jan 8, 2024

Musculotendinous ruptures of the achilles tendon had greater heel-rise height index compared with mid-substance rupture with non-operative management: a retrospective cohort study
Michael R. Carmont et al
Journal of ISAKOS; 27 December 2023

Introduction
Achilles Tendon Ruptures (ATR) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR.

Methods
The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace.

Results
From February 2009 to August 2023, 556 patients presented with an ATR. Of these 37 (6.7%) were diagnosed with a MT tear. At final follow up, at 12 months following injury, the MT group reported an Achilles tendon Total Rupture Score (ATRS) of mean (Standard Deviation (SD)) of 83.6 (3.5) (95% Confidence Interval (CI) 81.8, 85.4) and median (Inter-Quartile Range (IQR)) ATRS of 86 points (78-95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59-95) (p=0.673). Functional evaluation however, revealed statistically significant differences in mean (SD) heel-rise height index (HRHI) MT group 79% (25) (95%CI 65.9, 92.1) and MS group 59% (13) (95%CI 51.9, 67.1) (p = 0.019). In the MT rupture group, there were considerably less complications than the MS rupture group.

Conclusions
When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR.
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NewsBot · Jan 11, 2024

Incidence of Achilles tendon rupture: 25-year regional analysis with a focus on bilateral ruptures
Andrej Čretnik et al
Source

Objective
We aimed to fill the research gap regarding the incidence of Achilles tendon rupture (ATR), which is reportedly increasing, as there is a lack of data on the incidence of ATR and no data on bilateral ruptures in our region.
Methods
We determined the incidence of complete ATR among 273,485 people during 1991 to 2015.
Results
In the study period, 524 patients (486 [92.75%] men and 38 [7.25%] women, average age 39.03±10.86 [range 20–83] years, = sex ratio 12.8:1) were treated for ATR in our study area. The average incidence was 7.77 per 100,000 person-years, with an increasing trend until 2008 and peak incidence of 11.33 per 100,000 person-years. Most injuries (67.04%) occurred while performing sports activities. In total, 7 (1.34%) patients (six men [1.23%] and one woman [2.63%]) experienced ruptures on both sides, an average of 5.1 years apart; the average age at the second rupture was 57.71±16.69 (range 39–83) years, with a calculated incidence for bilateral ATR of 0.1 per 100,000 person-years.
Conclusions
The incidence of complete ATR in our study region increased gradually between 1991 and 2008, after which it declined. Bilateral ATR during that period was a very rare injury.
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Achilles tendon rupture

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