Achilles tendon rupture

NewsBot · Apr 6, 2026

Which Criteria Are Used to Clear Athletes to Return to Sport After Achilles Tendon Repair? A Scoping Review
Mattia Fernando Busà et al
Sports Health. 2026 Feb 17

Context:

Achilles tendon (AT) rupture is a devastating and potentially career-ending injury. Compared with other severe lower extremity injuries, such as anterior cruciate ligament reconstruction, it is associated with lower return to sport (RTS) rates, longer absence from training and competition, reduced sport-specific performance in the 2 years after rupture, shorter career length, and persistent long-term functional deficits. Therefore, better knowledge of the RTS criteria after AT rupture may support the optimization of rehabilitation outcomes and improve long-term RTS success.
Objective:

The purposes of this scoping review were to (1) map the scientific evidence regarding criteria used to clear patients to RTS after surgical AT repair, and (2) describe the predominant outcome measurements reported in the literature.
Data Sources:

Web of Science, Scopus, and MEDLINE databases.
Study Selection:

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework, including English-language studies published from 1995 to 2022 on “athletes” or “sportive patients” who underwent surgical AT repair.
Study Design:

Scoping review.
Level of Evidence:

Level 3.
Results:

Of 589 studies identified, 34 met the inclusion criteria: 3% were randomized controlled trials, 50% were case series, and 47% were cohort studies. None defined an outcome measurement as a criterion to RTS. The main outcomes were timeframe from surgery to RTS (53%), ankle range of motion (47%), Achilles Tendon Rupture Score (47%), calf circumference (44%), and heel-rise test (44%).
Conclusion:

None of the 34 studies defined an outcome measurements as criteria for RTS. The main measurements focused on the early rehabilitation stage, with limited standardization and a lack of assessment for the mid- and late stages of rehabilitation. Defining RTS criteria after AT repair may help optimize rehabilitation and the RTS process.
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NewsBot · Apr 6, 2026

Incidence, Temporal Trends, and Surgical Shift of Achilles Tendon Rupture: A Systematic Review and Meta-analysis
Roula Kotsifaki, Peter Malliaras, Christopher Byron, Joao Marques & Vasileios Korakakis
Sports Medicine

Background

Achilles tendon rupture is a severe injury affecting active and non-active populations, with considerable consequences on mobility, return to sport, and long-term function. Population-based incidence estimates provide important information for public health policy and resource allocation.
Objective

This systematic review and meta-analysis aimed to estimate the global incidence of Achilles tendon rupture, evaluate temporal trends over six decades, and analyze subgroup differences by sex, age, region, and sport participation. Additionally, we examined trends in surgical treatment over time.
Methods

A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. Six databases (PubMed, CINAHL, Embase, Web of Science, Index Medicus, and Google Scholar) were searched through April 2025 to identify population-based studies reporting Achilles tendon rupture incidence. Only studies based on registries or representative samples were included. Random-effects models were used to pool incidence rates, and meta-regressions assessed time trends and subgroup differences. Incidence rates were calculated per 100,000 person-years and stratified by sex, age, country, geographic region, and sport participation. Surgical treatment trends were analyzed using quadratic meta-regression. Risk of bias was assessed using the Joanna Briggs Institute tool.
Results

Twenty-eight studies reporting Achilles tendon ruptures from 1950 to 2022 were included, representing over 630 million individuals and 568,000 Achilles tendon rupture cases. The pooled global incidence was 15.7 per 100,000 person-years, spanning from 6.1 in 1979 to 31.1 per 100,000 person-years in 2021, with an average annual increase of 2.7% (95% confidence interval 2.0–3.3%). Male individuals exhibited a three-fold higher incidence than female individuals (pooled ratio 3.18; 95% confidence interval 2.50–4.04). Incidence peaked in male individuals aged 30–49 years (42.6 per 100,000 person-years) and in female individuals aged 40–49 years (17.2 per 100,000 person-years). Approximately 68% of Achilles tendon rupture were sport related. A significant shift in treatment patterns was observed: surgical repair rates peaked in 2003 and declined thereafter, indicating an increase in conservative treatment over the last 2 decades.
Conclusions

The incidence of Achilles tendon rupture has risen steadily over the last six decades, with the greatest burden observed among middle-aged physically active men. A majority of ruptures are sport related, highlighting the need for preventive interventions. Surgical treatment has declined since 2003, reflecting shifts toward conservative management. These findings underscore the importance of continued surveillance, targeted prevention, and individualized treatment strategies to reduce the growing burden of Achilles tendon rupture worldwide.
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NewsBot · Apr 8, 2026

MRI-Based Classification of Achilles Tendon Ruptures: Reliability and Predictors of Tear Location
Maximilian M Mueller et al
Orthop J Sports Med. 2026 Apr 3;14(4):23259671261428092.

Background: The absence of a comprehensive classification system for Achilles tendon (AT) injuries contributes to the lack of consensus regarding optimal treatment strategies, as it hinders accurate differentiation of injury types.

Purpose: To evaluate epidemiology of AT ruptures to develop a magnetic resonance imaging-based classification system for rupture location.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: A search was conducted for all patients with acute AT injuries between 2016 and 2023. Tear locations were classified as follows: type 1 (musculotendinous junction; MTJ), type 1A (2-cm zone distal to MTJ), type 2 (midsubstance), type 3 (2-cm zone proximal to insertion), type 3A (soft tissue "peel-off"), type 3B (calcaneal bony avulsion). Clinicodemographic data were collected, and rupture gap size, tendon thickness, tibiotalar, and plantarflexion angle were measured.

Results: A total of 428 patients were included (age 45 ± 15 years; 17% female). Mean rupture gap size was 30 ± 16 mm in 73°± 8° tibiotalar flexion. AT tear distribution: type 1, 62.7%; type 1A, 16.3%; type 2, 13.8%; type 3, 0.7%; type 3A, 5.8%; and type 3B, 0.7%. Female patients demonstrated lower tendon thickness (P < .001) and a significantly higher prevalence of type 3, 3A, and 3B (P < .001). Multivariate analysis revealed that proximal AT tears were associated with presence of tendinopathy (odds ratio [OR], 2.19; 95% CI, 1.24-3.83), while younger age and larger gap size were significant but with a weak effect size. Midsubstance tears were predicted by older age and increased tendon thickness (OR, 1.02-1.17). Distal tears were associated with absence of tendinopathy (OR, 0.17; 95% CI, 0.07-0.39), while age only had a small effect. Tear location measurements demonstrated substantial to almost perfect interobserver (3 observers; n = 35; Cohen's kappa = 0.93; 95% CI, 0.74-0.99) and intraobserver (1 observer; n = 35; Cohen's kappa = 0.93; 95% CI, 0.86-0.99) reliability.

Conclusion: This study introduces an AT tear classification system that demonstrated substantial to almost perfect reliability. AT ruptures at the MTJ were most common (63%). Presence of tendinopathy, age, gap size, and tendon thickness were significant predictors for AT tear type. Female patients exhibited lower tendon thickness and a significantly higher prevalence of distal tear location. Studies with larger cohort sizes are necessary to confirm the current findings.
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NewsBot · Apr 10, 2026

Investigation of the effects of morphometric characteristics of the foot on Achilles tendon rupture
Osman Hanbeyoğlu et al
BMC Musculoskelet Disord. 2026 Feb 24;27(1):266.

Background: Foot morphology plays a critical role in load distribution within the foot–Achilles tendon complex. However, the relationship between specific angular morphometric characteristics of the foot and Achilles tendon rupture (ATR) remains incompletely understood.

Methods: In this retrospective study, non–weight-bearing lateral foot radiographs of 147 male individuals aged ≥ 25 years were evaluated. The rupture group consisted of 72 patients diagnosed with ATR, and the control group included 75 healthy individuals with no prior history of trauma or rupture. A total of five angular foot morphometric parameters were assessed. Between-group comparisons were performed using independent t-tests or Mann–Whitney U tests, as appropriate.

Results: Significant differences between the rupture and control groups were observed in the Hibbs angle (124.49 ± 9.52° vs. 128.10 ± 7.58°; p = 0.012), Talar ground angle (20.29 ± 5.66° vs. 23.48 ± 4.69°; p < 0.001), Meary angle (12.55 ± 5.78° vs. 7.13 ± 4.81°; p < 0.001). No significant differences were detected for the remaining angular parameters.

Conclusions: Several angular foot alignment parameters differed between individuals with ATR and healthy controls. Significant differences between individuals with Achilles tendon rupture and healthy controls were identified in the talar ground angle, Meary angle, and Hibbs angle. These findings indicate that sagittal plane foot alignment, particularly longitudinal arch configuration and talar–first metatarsal orientation, may be associated with Achilles tendon rupture.
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NewsBot · Apr 11, 2026

Functional Evaluation of Acute Achilles Tendon Rupture
Treatment Using the Dresden Technique: A Case Series
Giovanni Fornino et al
Source

Aim and background: To evaluate functional outcomes, quality of life, and complications after repair of acute Achilles tendon rupture using a
minimally invasive Dresden technique. Achilles rupture is common, and management remains debated; minimally invasive approaches aim to
preserve functional outcomes while reducing soft tissue complications and sural nerve injury risk.
Materials and methods: Single-center case series (2015–2024) at a tertiary orthopedic institute. Adults with noninsertional acute ruptures
(≤2 weeks) underwent repair by two senior surgeons trained in the Dresden technique, using minor instrument modifications and a standardized
rehabilitation protocol. Outcomes included Foot and Ankle Outcome Score (FAOS), Achilles Tendon Total Rupture Score (ATRS), EuroQol
5-Dimension 5-Level questionnaire (EQ-5D-5L), Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function
v2.0–SF10a, heel-rise test, calf circumference, maximum plantarflexion/dorsiflexion, and gravitational equinus angle.
Statistics: Descriptive analyses; Spearman correlations among patient-reported outcomes; paired Wilcoxon tests for side-to-side comparisons.
Results: Thirty-one patients (mean age 37.0 ± 10.55 years; 64.5% male) completed follow-up. Mean scores: FAOS 99.03 ± 1.73, ATRS 98.29 ±
2.64, EQ-5D-5L 0.98 ± 0.03, PROMIS 61.0 ± 0.51 (range 60.3–61.5). Heel-rise: 24/31 (77.4%) maintained single-leg support. Complications: none
for infection, wound dehiscence, rerupture, or deep vein thrombosis (DVT); two transient sural nerve-related symptoms resolved by 2 months.
Plantarflexion: 25.42° (operated) vs 25.45° (nonoperated), mean difference 0.03° (SD 0.18), p > 0.05. Dorsiflexion and gravitational equinus: no
significant side-to-side differences. Calf circumference difference 1.08 cm (p < 0.05), not correlated with functional scores (p > 0.05). Very strong,
statistically significant intercorrelations were observed among FAOS, ATRS, EQ-5D-5L, and PROMIS.
Conclusion: The modified minimally invasive Dresden repair yielded excellent functional outcomes, high quality-of-life scores, and very low
complication rates, with no meaningful deficits in ankle range of motion. Calf atrophy was small and not functionally relevant.
Clinical significance: This technique appears safe, reproducible, and tissue-sparing, achieving outcomes comparable to open repair while
potentially mitigating soft tissue and nerve-related complications. Findings support its use in appropriate patients; prospective comparative
studies are warranted to confirm these results.
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NewsBot · Apr 11, 2026

Psychological and functional assessment of Achilles tendon ruptures and their return to sports
Rahul Mohan Kumar et al
Foot (Edinb). 2026 Apr 9:67:102237.

Introduction: Achilles Tendon Ruptures (ATR) in sport has only previously been investigated in an athletic population. Our aim in this study was to understand the psychology and function of ATR and their return to sport.

Methods: A historic cohort study was completed on patients attending our specialist Achilles clinic who had sustained an ATR during sport in a normal population. Patients completed ATRS (Achilles Tendon Total Rupture Score) and I-PRRS (Injury-Psychological Readiness to Return to Sport).

Results: 142 patients sustained ATR during sport and 73 patients had data available for analysis beyond 6 months. There were 17 (23.29%) who returned to same sport at the same level, 13 (17.81%) returned to same sport at different level, 11 (15.07%) who returned to different sport and 43.84% who did not return to sport. The I-PRRS and ATRS was significantly lower in the patients who did not return to sport (p < .001 and.003). There was significant correlation between the I-PRRS and ATRS. The most common reason for not returning to sport was fear of reinjury (41.30%), followed by pain/stiffness (26.09%) and life circumstance (13.04%). Although there was significant correlation between the ATRS and I-PRRS, the patients who did not return to sport at same level and gave reasons for non-return other than due to pain/stiffness, had normal ATRS scores CONCLUSIONS: Return to sport following ATR in a non-athletic population was low. The most common reason for failure to return to sport was psychological, however functional scores and psychological scores displayed significant correlation.

Summary box: Achilles tendon ruptures (ATR) have been primarily studied in professional athletes, leaving a gap in understanding outcomes in the general population. This study demonstrates that the return-to-sport rate in the general population following ATR is low, with fear of reinjury being the most common barrier, even among those with adequate functional recovery. These findings highlight the importance of integrating psychological rehabilitation with physical recovery protocols to improve return-to-sport outcomes.
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NewsBot · Apr 12, 2026

Polydeoxyribonucleotide improves scar healing following limited scar resection for chronic Achilles tendon rupture in a rat model
Journal of Orthopaedic Surgery and Research
Haochun Zhang, Wenguang Wu, Yun Su, Chi Xiao, Hongxun Wang, Fengcheng Cui, Weixuan Duan & Xiangjun Meng

Background

Chronic Achilles tendon rupture (CATR) results from delayed diagnosis or treatment, leading to retracted tendon ends filled with biomechanically inferior scar tissue. Limited scar resection (LSR) offers a less invasive surgical option by preserving and repairing scar tissue between tendon stumps, but the quality of healing remains suboptimal. Polydeoxyribonucleotide (PDRN) has demonstrated pro-healing properties in tendon disorders, yet its effects on scar remodeling after LSR are unknown.
Methods

Chronic Achilles tendon rupture was induced in male Sprague-Dawley rats by full-thickness transection without repair and 4 weeks of unrestricted activity. Animals were randomized into four groups: normal, control (conservative treatment), LSR, and LSR+PDRN. Outcomes were assessed at 3 and 6 weeks post-intervention via macroscopical scoring, biomechanical testing (maximum load, stiffness, stress), histology (modified Movin score), and immunohistochemistry (COL I/III expression).
Results

Compared to conservative treatment, LSR technique demonstrated a faster recovery of maximum load to baseline levels, regardless of whether it was combined with PDRN adjuvant therapy. With PDRN supplementation, stiffness was also restored to baseline. Biomechanical outcomes improved throughout the healing process in all experimental groups, with the LSR+PDRN group exhibiting higher maximum load, stiffness, and stress than both the control and LSR groups. At week 3, the LSR+PDRN group showed enhanced fibroblast proliferation and COL III secretion. By week 6, COL I expression was significantly better in the LSR+PDRN group compared to the control and LSR groups, although it still differed from that of normal Achilles tendon.
Conclusion

PDRN treatment enhances the biomechanical strength, histological structure, and COL I composition of the scar tissue following LSR in a rat model of CATR.
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NewsBot · Apr 18, 2026

Spontaneous Achilles tendon rupture as the initial presentation of ochronosis: a case report
Al-Zagebah, Ahmad MDa; Elazab, Mohamed PhDa; Muhtaseb, Rahaf MDb; Tamimi, Shaymaa N. S. MDb; Makhlouf, Taha Z. MDb,*
International Journal of Surgery Case Reports ():10.1097/RC9.0000000000000462, April 14, 2026. | DOI: 10.1097/RC9.0000000000000462

Introduction:

Alkaptonuria (AKU) is a rare autosomal recessive metabolic disorder characterized by homogentisic acid accumulation leading to ochronosis, which weakens connective tissues and may rarely affect tendons.
Presentation of case:

A 43-year-old man presented with sudden right ankle pain and functional loss without preceding trauma. Examination revealed a palpable gap and pigmentation of the sclera and ear. Intraoperatively, the Achilles tendon was friable and black. Histopathology confirmed ochronotic degeneration. Surgical repair using a modified Krackow suture with intraosseous anchoring achieved stable fixation and uneventful recovery.
Discussion:

This case illustrates spontaneous Achilles tendon rupture as an initial manifestation of AKU. Oxidative stress-induced collagen degeneration leads to tendon fragility. Recognition of characteristic pigmentation and histological features is essential for diagnosis.
Conclusion:

Ochronosis should be considered in unexplained tendon ruptures. Surgical repair and metabolic management, including nitisinone, can optimize outcomes.
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NewsBot · Apr 22, 2026

Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis of randomized controlled trials
Gabriel Moraes et al
Source

Introduction: Acute Achilles tendon rupture is a frequent and disabling injury. When early functional rehabilitation protocols are standardized, the independent effect of surgical versus nonoperative management on rerupture and complications remains unclear, as does the influence of surgical technique. Methods: A systematic review and meta-analysis of parallel-group randomized controlled trials was performed, including adults with acute (≤ 14 days), unilateral, closed Achilles tendon rupture. Nonoperative management with functional bracing and early rehabilitation was compared with open or minimally invasive surgical repair, with both groups following equivalent rehabilitation protocols. Searches of PubMed, Embase, and Cochrane were conducted following PRISMA guidelines. Primary outcomes at 12 months were rerupture and complications, including deep infection, superficial infection, and sural nerve injury. Risk ratios were pooled using a random-effects model, with prespecified subgroup analyses by surgical technique. Results: Seven randomized controlled trials, including 1,003 patients, were analyzed; 410 underwent nonoperative treatment and 593 surgical repair (410 open, 183 MIS). Nonoperative management was associated with a significantly higher 12-month rerupture rate than surgery (RR 3.35; 95% CI 1.35–8.30). No significant differences were observed in deep or superficial infection rates. Sural nerve injury was significantly less frequent in the nonoperative group (RR 0.20; 95% CI 0.05-0.85). Subgroup analysis showed persistently higher rerupture rates with nonoperative treatment than with open surgery, while superficial infection rates were lower in the nonoperative group. Conclusion: When early functional rehabilitation is standardized, surgical repair reduces the risk of rerupture at 12 months, whereas nonoperative management is associated with fewer sural nerve injuries. Treatment selection should be individualized based on patientspecific risks and priorities.
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NewsBot · Apr 25, 2026

Non-operative Treatment for Acute Achilles Tendon Rupture: Evaluation of Clinical Results and Tendon Lengthening on Magnetic Resonance Imaging
Toshito Yasuda et al
Foot Ankle Orthop. 2026 Apr 18;11(2):24730114261436395.

Background: In previous clinical studies of Achilles tendon (AT) ruptures, there are few reports measuring the AT length after conventional non-operative treatment without early functional rehabilitation. This study reviewed the outcomes of non-operative treatment for AT ruptures and assessed tendon length using magnetic resonance imaging (MRI).

Methods: Patients with acute AT rupture who underwent non-operative treatment were included in this retrospective study. In our department, conventional non-operative treatment without early functional rehabilitation is used to avoid excessive tendon lengthening in patients with AT rupture. Patients wore a below-the-knee cast and performed non-weight-bearing walking for 4 weeks. Subsequently, the cast was removed, and an ankle-foot orthosis was applied for 4-6 weeks. The mean follow-up period was 28 months. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the AT Total Rupture Score (ATRS). The tendon length and morphology were evaluated using MRI.

Results: Sixty-four patients (42 men, 22 women; mean age, 44 years) with acute AT rupture underwent non-operative treatment. The mean JSSF score and ATRS were 97 and 91 points, respectively. Among 43 athletes, 36 (83.7%) returned to their pre-injury level of sports participation. Tendon re-rupture occurred in 2 of 64 patients (3.1%). T2-weighted MRI revealed fusiform-shaped tendon thickening and homogeneous low-signal changes in all patients. The mean AT length measured by MRI after treatment was 66.4 mm.

Conclusion: Conventional non-operative treatment without early functional rehabilitation has a low re-rupture rate and favorable clinical outcomes, and MRI findings indicated good tendon healing in all patients. In our non-operative treatment, tendon lengthening increased up to 6 months post-injury. Overall, these results indicate that casting and non-weight-bearing for 4 weeks may represent a safe and effective treatment option associated with limited excessive tendon lengthening and re-rupture.
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NewsBot · May 10, 2026 at 9:32 PM

Current challenges and future directions in Achilles tendon rupture repair: A biomechanical perspective
Rongkai Xu et al
Journal of Biomechanics

The Achilles tendon (AT) fulfills critical physiological functions, such as transmitting plantar flexor forces, maintaining ankle stability, and buffering movement-related loads. Its exceptional mechanical performance stems from a multiscale hierarchical system, comprising macroscopic twisting tripartite subtendons, microscopic hierarchical fibers, and nanoscopic quarter-staggered and cross-linked collagen. Structural complexity leads to poor vascularity and limited self-repair capacity after Achilles tendon rupture (ATR), resulting in high re-rupture rates and inadequate mechanical restoration with conventional treatment. Current tissue engineering (TE) scaffolds offer promising alternatives, but face challenges such as unclear correlations between multiscale structures (twisting subtendons, fiber arrangement, collagen cross-linking) and mechanical behaviors (nonlinearity, negative Poisson’s ratio) and inadequate cross-scale structure–mechanics characterizations and analyses, hindering precise scaffold design and recapitulation of the structural and mechanical integrity of native AT. This review systematically summarizes AT’s macro–micro–nano structural characteristics, mechanical behaviors, and relevant characterizations, focuses on biomechanics-based TE scaffold strategies (structural design, biomaterial optimization, fabrication), analyzes existing limitations (insufficient quantification of cross-scale correlations, difficulty in balancing multiscale topology, and mechanical compatibility), and proposes future research directions centered on refining cross-scale quantitative laws and developing multiscale synergistic biomimetic scaffolds. This review provides the theoretical and technical references for innovative ATR repair research by integrating interdisciplinary advances in biomechanics, materials science, and TE.
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NewsBot · May 11, 2026 at 6:10 AM

Randomised three-armed trial investigation of the Copenhagen Achilles tendon Rupture Treatment Algorithm (CARTA) for individualised treatment of acute Achilles tendon rupture
Marianne Toft et al
Br J Sports Med. 2026 May 4

Objective: To evaluate whether individualised treatment using the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) is superior to default operative or non-operative strategies.

Methods: We conducted a multicentre, three-arm, randomised controlled trial. Adults with acute Achilles tendon rupture were randomised (1:1:1) to individualised CARTA, non-operative or operative treatment. In the CARTA arm, surgery was indicated if ultrasound showed<25% tendon overlap or ≥7% elongation. The primary outcome was the Heel-Rise Work Test (HRWT) at 12 months. Secondary outcomes included HRWT at 6 months, and at both 6 and 12 months, the Heel-Rise Height, Achilles tendon Total Rupture Score (ATRS), Tegner activity scale, Copenhagen Achilles tendon Length Measure, Achilles Tendon Resting Angle (ATRA) and complication recordings.

Results: Between May 2018 and June 2023, 970 patients were screened; 300 were randomised (male/female 76%/24%, mean age 41 (SD 1)). At 12 months, data were available for 98 CARTA (64% operated), 100 non-operative and 97 operative patients. There were no significant between-group differences in HRWT at 12 months. However, CARTA significantly reduced rerupture rates by 73% compared with non-operative treatment (3% (95% CI) (1 to 8) vs 11% (6 to 19), p=0.03), improved ATRS by 8 points (1 to 15, p=0.02) and improved ATRA by -2° (-4 to -1), p=0.01). No difference between CARTA and operative treatment was found except 36% less underwent surgery.

Conclusion: Individualised CARTA did not improve functional outcomes based on the HRWT at 12 months, but among secondary outcomes, it reduced rerupture rates and improved patient-reported outcomes compared with non-operative treatment and with fewer surgeries than routine operative care.
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NewsBot · May 13, 2026 at 10:21 PM

Modified Rush Technique With Plantaris Tendon Augmentation for Chronic Achilles Tendon Rupture: Surgical Technique and Preliminary Clinical Outcomes
Nazim Sifi et al
Cureus. 2026 May 11;18(5):e108625.

Background Chronic Achilles tendon rupture remains a challenging condition, particularly in cases involving large tendon defects that preclude end-to-end repair. Among reconstructive options, techniques using local tissues avoid the donor-site morbidity associated with tendon transfers. This study describes a modified gastrosoleus fascial turndown flap based on the Rush technique, reinforced with the plantaris tendon, and reports preliminary clinical outcomes. Methodology A total of 13 patients presenting with chronic Achilles tendon rupture (≥4 weeks) with a defect ≥6 cm were included. All underwent reconstruction using a tubularized gastrosoleus fascial flap based on the Rush principle, combined with plantaris tendon augmentation in a framing configuration. Outcomes were assessed using the Achilles Tendon Total Rupture Score (ATRS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the ability to perform heel raises. Body mass index (BMI) was analyzed descriptively as an exploratory variable, given the limited sample size precluding formal statistical analysis. Results At a mean follow-up of 16.1 ± 2.7 months, the mean ATRS was 81.0 ± 3.9, and the mean AOFAS score was 83.9 ± 2.3. Patients performed a mean of 14.5 ± 1.3 single-leg heel raises. No reruptures or complications were observed. The mean BMI was 25.2 ± 3.4 kg/m², with a slight decrease in ATRS observed in overweight patients. Conclusions The modified Rush technique with plantaris tendon augmentation appears to be a reproducible biological option for the management of chronic Achilles tendon ruptures with large defects. In this preliminary series, satisfactory functional outcomes were observed, supporting the feasibility of a fully biological reconstruction strategy using local tissues without tendon sacrifice. This approach may represent a potential alternative to tendon transfers for defects ≥6 cm.
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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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