Complete Achilles Tendon Rupture Research Articles

Optimizing Achilles Tendon Rupture Care: The Efficacy of Physiotherapy-Led Conservative Management in a District General Hospital.

Introduction Achilles tendon rupture (ATR) represents a significant musculoskeletal injury that can affect many patients' mobility and quality of life.Treatment of ATR consists of both conservative and surgical options, with the traditional belief being that surgical intervention reduces the risk of re-rupture. However, with the introduction of physiotherapy-led functional rehabilitation strategies with early mobilization, ithas been shown that re-rupture rates are equal amongsurgical and non-surgical patients.This study focuses on evaluating the effectiveness of non-surgical, physiotherapy-led management, specifically within the context of patients at a district general hospital. The rationale for investigating this approach lies in the growing interest and adoption of conservative management strategies for ATR across orthopaedic practices within the National Health Service (NHS). Methods This is a retrospective cross-sectional study assessing the efficacy of the physiotherapy-led treatment pathway in our district general hospital. Data were retrospectively collected from Hive, which is the trust's electronic patient record (EPR) and has comprehensive access to all patients' history, notes, images, investigations, and previous letters. We looked at all patients treated by physiotherapists for ATR from September 2022 to December 2023. Results In total, 76 patients were treated along the physiotherapy-led pathway for ATR between September 2022 and December 2023. The ages ranged from 22 to 82 years, with a mean age of 47 years. Of the patients,48.6%(n = 37) were in the 40-60 years age range. The gender distribution was 69.7% (n =53) males and 30.3% (n =23) females (total = 76).The injury characteristics revealed a predominance of complete ATR, with 88.1% (n = 67) of cases being complete ATR, and 11.9% (n = 9) being partial ATR.Patients experiencing re-ruptures ranged from 34 to 64 years old, with three males and one female. Re-escalation to a consultant in only 14.5% of cases (n = 11) reflects successful initial management, minimizing the need for further interventions.Based on the available data, on average, younger patients (≤49 years) returned to work approximately 5.7 weeks post injury(n = 32). Conversely, older patients (above the average age) took 13.5 weeks on average to return to work. The dataset revealed that, on average, patients under the physiotherapy-led pathway returned to sports activities in about 29.9 weeks.Thromboprophylaxis was prescribed for 93.5%(n = 71) of patients with ATR. The data revealed a low incidence rate of deep vein thrombosis with only 4%(n = 3) of patients experiencing this complication post rupture. Conclusion This audit offers insight into physiotherapy-led ATR management at Wythenshawe Hospital, evaluating treatment resultsand challenges. The findings suggest that a conservative approach is effective in promoting patient recovery, with low re-rupture rates and successful return-to-function outcomes. While limitations such as sample size and retrospective design exist, the findings underscore the need for tailored rehabilitation protocols and continued research to optimize patient care in ATR management.

Treatment of Achilles tendon rupture in a patient with alkaptonuric ochronosis

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

Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy.

The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT. To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity. Cohort study (diagnosis); Level of evidence, 3. The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests. The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001). The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

Comparative Study between Operative and Non-Operative Management of Complete Achilles Tendon Rupture

ntroduction Achilles tendon rupture is the most common tendon rupture in the lower extremity. The injury most commonly occurs in adults in their third to fifth decade of life.[1] Acute ruptures often present with sudden onset of pain associated with a "snapping" or audible "pop" heard at the site of injury. Patients can describe the sensation of being kicked in the lower leg. The injury is causes significant pain and disability in patient populations. Achilles tendon injuries typically occur in individuals who are only active intermittently (i.e., the "weekend warrior" athletes). The injury is reportedly misdiagnosed as an ankle sprain in 20% to 25% of patients. Most commonly affected as 10% report a history of prodromal symptoms, and known risk factors include prior intratendinous degeneration, fluoroquinolone use, steroid injections, and inflammatory arthritides.[2,3]

Progression of partial to complete ruptures of the Achilles tendon during rehabilitation: Astudy using a finite element model.

Substantial research on complete Achilles tendon ruptures is available, but guidance on partial ruptures is comparatively sparse. Conservative management is considered acceptable in partial tendon ruptures affecting less than 50% of the tendon's width, but supporting experimental evidence is currently lacking. Using a previously validated finite element model of the Achilles tendon, this study aimed to assess whether loading conditions simulating an early functional rehabilitation protocol could elicit progression to a complete rupture in partial ruptures of varying severity. In silico tendon rupture simulations were performed to locate the most likely rupture site for least, moderate, and extreme subtendon twist configurations. These three models were split at the corresponding rupture site and two sets of partial ruptures were created for each, starting from the medial and lateral sides, and ranging from 10% to 50% loss of continuity. Simulations were conducted with material parameters from healthy and tendinopathic tendons. Partial ruptures were considered to progress if the volume of elements showing a maximum principal strain above 10% exceeded 3 mm3. To assess whether the tendinopathic tendons typical geometric characteristics could compensate for the inferior material properties found in tendinopathy, an additional model with increased cross-sectional area in the free tendon region was developed. Progression to complete ruptures occurred even with less than a 50% loss of continuity, regardless of subtendon twisting, and material parameters. The tendinopathic tendon model with increased cross-sectional area showed similar results. These findings suggest the current criteria for surgical treatment of partial ruptures should be reconsidered. Statement of clinical significance: The clinical significance and most appropriate treatment of partial ruptures of the Achilles tendon is unclear. Despite the widespread use of the "50% rule" in treatment decisions of partial tendon ruptures, experimental evidence supporting it is missing. The present study provides new data, from a validated aponeurotic and free Achilles tendon finite element model, showing that partial ruptures may progress to complete ruptures under loading conditions elicited from functional rehabilitation protocols, even for partial ruptures affecting less than 50% of the tendon's width. Under these novel findings, the current criteria for surgical treatment of partial ruptures should be reconsidered.

Delayed Diagnosis of Complete Achilles Tendon Rupture in a Teenage Athlete: A Case Report of Nonoperative Treatment.

A 19-year-old female athlete experienced calf pain during sport. A complete Achilles tendon rupture was diagnosed 4 weeks after injury. Ultrasound revealed discontinuity of the Achilles tendon with 2.0 cm of diastasis, persisting in plantarflexion. Plantarflexion immobilization was initiated, and progressive dorsiflexion was used until 10 weeks from injury. At 1 year from injury, ankle magnetic resonance imaging revealed a contiguous tendon, the patient was pain-free, and had returned to high-level athletics with equivalent sport performance relative to her preoperative status. Certain Achilles tendon ruptures in young people may be treated nonoperatively with good clinical outcomes, even if diagnosis and immobilization are delayed and tendon diastasis persists in maximum plantarflexion.

FGF-2 enriched nanofiber scaffold for advancing achilles tendon healing: a comparative experimental investigation.

Achilles tendon rupture is a common and debilitating injury that significantly impacts mobility and quality of life. Effective treatment options that promote faster and more complete healing are needed. Fibroblast growth factor-2 (FGF-2) has shown potential in enhancing tendon repair. This study aims to investigate the efficacy of FGF-2 in promoting tendon healing in a rat model of Achilles tendon rupture, providing insights into its potential as a therapeutic option. Forty-eight rat hind legs with complete Achilles tendon ruptures were divided into four equal groups: the Sham (S) group (tendon repair only), the Polymer (P) group (tendon repair with scaffold wrapping), the Produced FGF-2 (PF) group (scaffold coated with lab-produced FGF-2), and the Commercial FGF-2 (CF) group (scaffold coated with commercially sourced FGF-2). Histological analyses at two and four weeks post-surgery evaluated healing based on nuclear morphology, vascularity, fibril organization, inflammation, and adipogenesis. At the end of the second week, no macroscopic healing was observed in one rat each from the S and P groups. By the end of the fourth week, macroscopic healing was observed in all groups. The S and P groups exhibited similarly severe fibril disorganization, pathological adipogenesis, and sustained inflammation, particularly at the fourth week. In contrast, the CF group demonstrated improved tendon healing with increased vascularity and extracellular matrix, lower inflammatory cell infiltration, and better fibril organization. Pathological adipogenesis was absent in the CF group, especially at the fourth week. The PF group showed comparable improvements at the second week but experienced a relapse by the 4th week, with increased inflammation and adipogenesis. FGF-2 coated scaffolds significantly enhanced tendon healing in a rat Achilles tendon rupture model by improving fibril organization, increasing vascularity, and reducing inflammation and pathological adipogenesis. These findings suggest that FGF-2 could be a promising therapeutic option for accelerating tendon repair. Future perspectives on tendon repair will focus on enhancing FGF-2 delivery using innovative scaffolds, paving the way for more effective therapies and improved patient outcomes.

Achilles Tendon Rupture Treated with Flexor Digitorum Lateralis Tendon Transposition and Transarticular External Skeletal Fixator in Ouessant Sheep

Abstract Objective To describe the appositional augmentation of a complete Achilles tendon rupture in Ouessant sheep, using the intact flexor digitorum lateralis tendon, and immobilization with a type II transarticular external skeletal fixator. Clinical Report A 1-year-old neutered male Ouessant sheep was presented for Achilles tendon rupture and multiple bite wounds, secondary to a dog attack. The Achilles tendon was torn entirely, and a significant 3-cm gaping defect was present. The remnants of the Achilles tendon were debrided and attached using locking-loop and epitendinous sutures. The intact flexor digitorum lateralis tendon was then transposed and secured over the tendinous repair to increase the tendon strength. The bite wounds were closed with a primary repair. Finally, a type II transarticular external skeletal fixator was used to immobilize the tarsocrural joint for 6 weeks. Results A mild lameness, associated with a decreased range of motion of the tarsocrural joint, was present at the time of external skeletal fixator removal. Four months postoperatively, the lameness had completely resolved. A slight decrease in the range of motion of the tarsocrural joint was conserved. Clinical Significance In a small ruminant, transposition of the flexor digitorum lateralis was successful for the repair of an Achilles tendon rupture with a large musculotendinous gap and infected open wounds. To the authors' knowledge, this is the first such case described in sheep.

Incidence of Achilles tendon rupture: 25-year regional analysis with a focus on bilateral ruptures.

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. We determined the incidence of complete ATR among 273,485 people during 1991 to 2015. 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. 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.

Thromboembolic Events During Weightbearing vs Nonweightbearing Accelerated Rehabilitation Protocols for Complete Achilles Tendon Ruptures.

Achilles tendon rupture can be treated nonoperatively with functional rehabilitation. However, prolonged immobilization has associated risk of venous thromboembolism (VTE). Early weightbearing may reduce VTE risk, and this was introduced to our rehabilitation protocol. We investigated the prevalence of symptomatic VTE events before and after the introduction of the early weightbearing protocol. Adults with ultrasonography-confirmed complete tendo-Achilles ruptures between January 2017 and June 2020 were included. Preprotocol, patients were instructed to not weightbear for 4 weeks. In 2018, immediate weightbearing was introduced to the treatment protocol. All patients in both cohorts were given low-molecular-weight heparin for 4 weeks. Patients with symptomatic VTE events were investigated with duplex ultrasonographic scan or chest computed tomography. Two independent anonymized examiners collected data from electronic records. Rates of symptomatic VTEs were compared. A total of 296 patients were included. Sixty-nine patients were managed with the nonweightbearing protocol, and 227 patients were managed with the early-weightbearing protocol. Two patients in each group developed deep vein thrombosis and 1 developed pulmonary embolism in the early-weightbearing group. Rates of VTEs were lower in the early-weightbearing group (1.3% vs 2.9%) but did not reach statistical significance (P = .33). In this cohort we found that symptomatic VTE after nonoperatively treated Achilles tendon rupture was uncommon. We did not demonstrate a reduction in symptomatic VTE between our early weightbearing and nonweightbearing rehabilitation protocols. We believe a larger study may help clarify whether early weightbearing is beneficial in VTE reduction. Level III, retrospective cohort study.

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft: A Case Report.

A 15-year-old adolescent girl presented with a complete Achilles tendon rupture from playing netball, which was diagnosed 6 weeks later. Unfortunately, there was a significant deficit of 92 mm, and an allograft reconstruction was required to bridge the gap. Achilles tendon ruptures are rare in children and adolescents without a penetrating injury, but the diagnosis must not be missed. Achilles tendon ruptures should be considered in children with acute-onset ankle pain during running, jumping, or sudden dorsiflexion of the ankle. Tendon transfers and allograft may be required after rupture and retraction has occurred in subacute or chronic injuries.

Observation on the Effect of Rehabilitative Physical Training on Sports Injuries under Ultrasound Image Examination.

In order to observe the effect of rehabilitative physical training on sports injuries under ultrasound examination, this study firstly carried out experiments, induction and analysis of ultrasound examination, and evaluation-related content, especially the diagnosis of ultrasound examination in muscle and tendon injuries caused by various reasons. And the clinical application of treatment (clinical research) is reviewed, in order to provide reference data for clinical stage summary. Then, by determining the fasciculation and location of the tendon rupture injury by ultrasound, the clinic can decide whether or not to proceed with surgery. Small Achilles tendon tears only require conservative treatment to avoid the development of complete Achilles tendon rupture. Finally, 26 patients and 10 healthy adults were examined by ultrasonography, and each subject was segmented to examine 11 muscles, including the tongue muscle. The bilateral trapezius, bilateral biceps brachii, bilateral abductor pollicis brevis, bilateral quadriceps femoris, and bilateral tibialis anterior muscles were evaluated by ultrasound and statistical methods. The experimental results show that if the fasciculation of the Achilles tendon injury does not reach more than 3/11, it indicates that no surgical treatment is required; for those with a complete tear of the Achilles tendon, the distance between the broken ends should be further measured in the toe flexion state to evaluate whether surgical treatment is required. It effectively solves the problem of visual diagnosis of sports injuries.

Mini-Open Achilles Tendon Repair: Improving Outcomes While Decreasing Complications.

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.Level of Evidence: 3 (retrospective cohort study N ≥ 30).

Full Thickness Achilles Tendon Tears: Two Case Studies

The Achilles tendon is the largest and strongest tendon in the body. With increasing age and repetitive use, the Achilles tendon is more prone to injury, ranging from a mild injury to a full thickness tear. Achilles tendon injuries are one of the most common sporting injuries, and sonography may be the first imaging modality used to diagnose. Technologists must be familiar and able to recognize partial and full thickness tendon tears to assist in accurately diagnosing these injuries. Both the case studies provided demonstrate patients involved in sporting activities that resulted in complete Achilles tendon ruptures.

Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis.

Achilles tendon rupture is a common injury with increasing incidence due to the rising popularity of high-velocity sports, continued physical activity of the aging American population, and use of fluoroquinolones and steroid injections. The diagnosis can often be missed or delayed, with up to 20% misdiagnosed, most commonly as an ankle sprain. The aim of our study was to systematically evaluate the reported sensitivity, specificity, and likelihood ratios of ultrasound for detecting Achilles tendon rupture in patients who were treated surgically. In January 2020, we performed a literature search of MEDLINE and EMBASE databases to identify eligible articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were original studies with at least five patients, which reported data on the sonographic diagnosis of Achilles tendon rupture (complete or partial) compared to surgery as the reference standard. A total of 15 studies with 808 patients were included in the primary analysis. The sensitivity of ultrasound for detecting complete Achilles tendon ruptures was 94.8% (95% confidence interval [CI] 91.3-97.2%), specificity was 98.7% (95% CI 97.0-99.6%), positive likelihood ratio was 74.0 (95% CI 31.0-176.8), and negative likelihood ratio was 0.05 (95% CI 0.03-0.09), in patients who underwent surgical treatment. The results from our study suggested that a negative ultrasound result may have the potential to rule out a complete, as well as a partial, Achilles tendon rupture.

Minimally Invasive versus Open Repair for the Treatment of Acute Achilles Tendon Rupture in Adults: A Prospective Randomized Controlled Study

Abstract BACKGROUND The aim of this study is to compare open repair and minimally invasive repair in acute Achilles tendon rupture in adults regarding operative techniques, functional outcome and complications. DESIGN A prospective randomized controlled comparative trial. METHODS 40 consecutive cases with acute complete Achilles tendon rupture were divided randomly in 2 equal groups (20 treated by open Krackow repair and 20 treated by minimally invasive repair with the PARS device), average age 41 years, follow up time was average of 7 months. Patients were assessed clinically and functional scoring system of postoperative American Orthopaedic Foot &amp; Ankle Society ankle-hindfoot score (AOFAS) was used postoperatively. RESULTS Our results found that there were no significant differences between both groups in rates of postoperative complications (MIS group 10%, open repair group 15; P = 0.134). PARS group had greater postoperative AOFAS score, early rehabilitation, better cosmetic appearance and smaller scar length than open Krackow repair of acute Achilles tendon rupture. CONCLUSIONS We have found out that minimally invasive techniques such as the PARS are clinically and biomechanically suitable alternatives to open repair based on both clinical outcomes and repair strength.

Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis

BackgroundThe optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures. MethodologyThis study was done at East Kent Hospital University Foundation Trust in between 2019−2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score. ResultOur study population was predominantly male with an average age of 50 (range 22−79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions. ConclusionEarly weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome.

Outcome of Achilles Tendon Repair using Four Strand Cross Locked Cruciate Repair Technique

Background Four strand cross locked cruciate tendon repair technique for Achilles tendon rupture has shown promising result.&#x0D; Objective To evaluate the outcome of all acute traumatic Achilles tendon rupture case treated by a novel repair technique of four strand cross locked cruciate.&#x0D; Method A total of 40 cases of acute traumatic Achilles tendon rupture from 2011 to 2018 treated by four strand cross locked cruciate repair technique were retrospectively evaluated using Achilles Tendon Total Rupture Score.&#x0D; Result Average age of patient was 29.45 years. Male preponderance was seen. Most of the patient (97.5%) had complete rupture of Achilles tendon. Most of the patient (92.5%) had open injury. The average length of hospitalization was 7 days. All the patients recovered to the level of physical activity previous to the tendon lesion. The achilles tendon total rupture score significantly improved from 6 month post op period to 12 months (p=0.02) and 2 years post op period (p=0.038).&#x0D; Conclusion The optimum method of suturing technique for acute traumatic rupture of Achilles tendon remains controversial. The four strand cross locked cruciate repair technique provides a stable and reliable construct for the Achilles tendon repair. The technique requires further investigation with direct comparison with other mostly used techniques like Krackow and Gift box suture technique.

Video-based biomechanical analysis of an unexpected Achilles tendon rupture in an Olympic sprinter

We used image-processing techniques to determine the moment (i.e., image frame) of the Achilles tendon (AT) rupture in an Olympic sprinter. This report may be unique due to the difficulty in conducting motion capture analyses during injury events. Our report includes one female Olympic sprinter, 29 years old (body mass: 56 kg, height: 1.68 m, and body mass index: 19.8 kg/m2) with a high-competitive profile history (2008 and 2012 Olympic Games participation; South American record holder in 100- and 200-m; Pan-American gold medalist in 200-m and 4 × 100-m relay) who suffered a complete AT rupture in the left leg while exercising in the final phase of rehabilitation following an Achilles tendinopathy in the contralateral limb. The greater dorsiflexion found at the moment of the injury and the delayed control of heel position indicated the presence of uncontrolled dorsiflexion, which potentially generated excessive eccentric stress over the tendon and, thus, the AT rupture. Here we discuss the relevance of lower leg alignment, the movements’ characteristics, and the history of Achilles tendinopathy in the contralateral leg on the occurrence of the AT rupture.

Achilles Tendon Repair With Modified Giftbox Technique Using Nonabsorbable Suture Loops

Background: Achilles tendon ruptures occur most commonly in male individuals aged between 30 and 60 years. Indications: Surgical options for treatment of acute midsubstance Achilles tendon ruptures in the athletically active population include open, mini-open, and percutaneous techniques. Surgical Technique: The giftbox suture configuration has been popularized by multiple authors. Here, a modified giftbox technique for Achilles tendon repair is shown in detail and uses nonabsorbable suture loops, a novel method for primarily repairing complete Achilles tendon ruptures. Results: This mini-open technique has demonstrated, at a minimum of 1-year follow-up, outcomes that are comparable with previously reported Achilles tendon repair procedures with no re-ruptures and low overall complication rates in the first 60 patients who have undergone this procedure. The mean time to release to unrestricted activity following repair by this technique is 24.3 weeks, which is earlier than most standard techniques. Conclusion: Achilles tendon repair using the modified gift box technique with nonabsorbable suture loops is a safe and reliable technique for repair of midsubstance tendon ruptures in athletically active patients. The mean time to release to unrestricted activity following repair by this technique is earlier than most standard techniques.