Achilles Tendon Rupture Research Articles

Modified Minimally Invasive Bunnell Suture Surgery with Channel-assisted Minimally Invasive Reconstruction Device for Treating Achilles Tendon Rupture.

The aim of this study was to improve the process of microincision and endoscopic surgery for the treatment of Achilles tendon (AT) rupture using the modified minimally invasive Bunnell suture (MIBS) technique.From December 2019 to December 2021, 20 patients with AT rupture who visited the First Affiliated Hospital of Harbin Medical University (Harbin, China) underwent MIBS surgery.A total of 20 patients were included, of whom 18 (90.0%) were male and 2 (10.0%) were female. The mean age of the patients was 37.75±9.94 years. In terms of the site of the AT, two (10.0%) had surgery on their left AT. The mean duration of surgery was 23.00±2.47 minutes, and the mean bleeding volume was 5.00±1.12mL. All 20 patients (100%) showed complete incisional healing (stage I healing) and normal functional recovery (3-6 months postoperatively). There were no cases of abnormal functional recovery or postoperative recurrence within the 3-6 month follow-up period. The Achilles tendon Total Rupture Score (ATRS) significantly improved post-surgery (83.6±5.59) compared to pretreatment (0.3±0.92, p<0.0001), indicating successful patient recovery.After the modified MIBS surgical process, the operation steps were simplified, the surgical difficulty was reduced, and the surgical trauma was alleviated, resulting in good postoperative recovery and patient satisfaction with the outcome. Therefore, the MIBS surgery has high promotability.

Short-term outcomes of all-inside endoscopic running locked stitch technique for acute achilles tendon ruptures

Objective: To evaluate the short-term outcomes of all-inside endoscopic running locked stitch technique for acute Achilles tendon ruptures. Methods: This is a retrospective case series study. Forty cases with acute Achilles tendon rupture were treated with the all-inside endoscopic running locked stitch technique from April 2020 to March 2022. There were 44 males and 4 females, aged (34.8±7.4) years (range: 24 to 50 years). Body mass index was (21.2±2.4)kg/m2 (range: 18 to 26 kg/m2); There were 29 cases (60.4%) on the left side and 19 cases (39.6%) on the right side. Under endoscopic control, the proximal tendon stumps were stitched with the running locked method using a semi-automatic flexible suture passer. The threads of the high-strength suture were grasped through the paratenon sub-space and then fixed into calcaneal insertion with a knotless anchor. MRI of Achilles tendon, surgical time and complications were assessed. Achilles tendon total rupture score (ATRS), Achilles tendon resting angle, and heel rise height scale were utilized to evaluate final clinical outcomes. The differences of bilateral limbs were compared using the paired t test. Results: The follow-up time was (24.1±3.5)months (range:18 to 32 months). Appropriate tendon regeneration was observed on MRI at post-operative 12 months. The median ATRS score (M(IQR)) was 95.0 (4.7) points. Furthermore, there was no significant difference between the injured and contralateral side in the Achilles tendon resting angle ((17.1±2.4)° vs. (17.4±2.6)°, t=1.92,P=0.062) and heel rise height ((14.2±1.7)cm vs. (14.4±1.5)cm, t=1.71,P=0.094). No nerve injuries, infection, deep vein thrombosis and re-ruptures were encountered. Sports activity resumed six months postoperative in 46 patients. One patient had a slight anchor cut-out, due to an addition injury, which was removed after 5 months. Conclusions: All-inside endoscopic running locked stitch technique for acute Achilles tendon ruptures shows promising results. It provides stable connection of the tendon stumps with a low risk of complications.

The current status and challenges of surgical treatment for chronic Achilles tendon rupture

With the growing demand for physical activity, an increasing number of individuals with chronic Achilles tendon ruptures are opting for surgical intervention. Surgical approaches encompass end-to end anastomosis, tendon flap techniques, tendon transfer procedures, and free tendon grafting, among others. When selecting the appropriate surgical method and determining the surgical indications, it is imperative to consider factors like the length of the Achilles tendon defect, patient age, aesthetic preferences, functional requirements, and local tissue conditions. As medical devices evolve and surgical techniques advance, the criteria for surgical intervention are also evolving. Drawing from existing literature evidence, it becomes crucial to define reasonable parameters for addressing Achilles tendon defects with each surgical technique, aligning more closely with clinical needs. Additionally, auxiliary technologies such as biologic therapy and innovative biomaterials have demonstrated promising results in laboratory or animal models. The focal point of advancing these auxiliary technologies lies in facilitating the translation of pertinent clinical outcomes in the future.

Females present larger deficit in heel-rise height at 3 months following an Achilles tendon rupture compared with males.

There is a lack of knowledge concerning differences between females and males in the early stages after an acute Achilles tendon rupture. This article aims to explore the different factors affecting early function after an Achilles tendon rupture with a validated test battery that includes functional tests, clinical measurements and patient-reported outcome at a 3-month follow-up analysis of a larger prospective study. This study was part of the DUSTAR-study (Diagnostic UltraSonography for the choice of Treatment of acute Achilles tendon Rupture) where the main aim was to evaluate if an acute ultrasonography could determine which patients, with an Achilles tendon rupture, should be treated surgically or nonsurgically. At the 3-month follow-up, the results between males and females were compared. One hundred and twenty-seven patients were included at the 3-month follow-up; of these, 102 (80%) were males and 25 (20%) were females. Amongst the females, 11 (44%) were able to perform a single leg heel-rise compared to 48 (47%) of the males; however, the difference was not statistically significant. There was no difference between the sexes in the frequency of completing a single-leg heel-rise at 3 months after injury; however, there were statistically significant differences between the groups when comparing Limb Symmetry Index (LSI) of heel-rise height and heel-rise work. The females had a median heel-rise height LSI/median heel-rise work LSI of 45%/14% compared to males who reached a level of 57%/23% (p = 0.006/p = 0.010). At the 3-month follow-up, the median (range) Achilles tendon Total Rupture Score (ATRS) reported by females was 28.5 (8-51), which had a nonsignificant difference compared to males who reported a median (range) ATRS of 30 (1-86). The risk of reduced heel-rise height and worse heel-rise work 3 months after an acute Achilles tendon rupture increases by being a female. Through this knowledge, we highlighted the importance of an individualised treatment for acute Achilles tendon ruptures with better outcome for both males and females. Level II.

Feasibility of an early progressive resistance exercise program for acute Achilles tendon rupture

BackgroundLong-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with the intervention.MethodsWe recruited patients with an acute Achilles tendon rupture treated non-surgically. During 9 weeks of immobilisation with a walking boot, participants attended weekly supervised physiotherapy sessions of progressive resistance exercises and performed home exercises, consisting of isometric ankle plantarflexion, seated heel-rise, and elastic band exercises. Acceptability was evaluated using a 7-point Likert scale (1 = very unacceptable and 7 = very acceptable) with feasibility threshold at 80% of the participants rating ≥ 4. Adherence to the exercises was defined as 80% of the participants performing at least 50% of the home exercises. During the intervention, tendon healing and adverse events were monitored.ResultsSixteen participants (mean age 46 (range 28–61), male/female = 13/3) completed the intervention. Pre-injury Achilles tendon total rupture score was 98 (SD 8). All participants rated the acceptability of the exercises ≥ 5 (moderate acceptable to very acceptable) at 9- and 13-week follow-up and 9/16 rated 7 points (very acceptable). Participants performed 74% (range 4–117) of the total prescribed home exercises and 15/16 performed > 50%. One participant was not compliant with the home exercises due to feeling uncomfortable performing these independently. There were no re-ruptures, but one case of deep venous thrombosis.ConclusionsThe early progressive resistance exercise program for treatment of non-surgically treated Achilles tendon rupture was feasible. Future studies should investigate the efficacy of the progressive intervention.Trial registrationThe study was registered at Clinical Trials (NCT04121377) on 29 September 2019. ClinicalTrials: NCT04121377.

Commentary on 'Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials'.

Commentary on 'Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials'.

Ultrasound assessment of acute Achilles tendon rupture and measurement of the tendon gap.

Achilles tendon rupture is a common sports-related injury which can carry significant morbidity to patients. Ultrasound remains the workhorse of imaging as it can confirm and localise the extent of Achilles tendon injury. The sonographic anatomy, both normal and ruptured sonographic appearances, as well as sonographic technique must be appreciated to accurately image and report findings, critical to patient management. Particular attention should be applied to the measurement of the diastasis between acutely ruptured tendon ends as this information can assist with informing the decision of conservative vs. operative management. Further work is necessary to standardise the measurement technique including correlating the degree of plantarflexion of the foot with the sonographic tendon gap measures.

Clinical and functional outcomes of 405 Achilles tendon ruptures after a minimum follow-up of 1 year

ObjectiveThe results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results. HypothesesThere is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols. MethodsThis was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review. ResultsFour hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07). ConclusionsThis study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes. Level of evidenceIII; retrospective comparative, non-randomized.

Role of Ultrasound Investigation in Acute Achilles Tendon Rupture

Objectives: This study aims to investigate the reliability of ultrasound in differentiating between partial and complete TA ruptures. It also aims to establish whether ultrasound findings of TA ruptures are in accordance with intraoperative findings.Method: The authors identified all cases of Achilles tendon rupture treated operatively in a unit over the course of the year. Charts were reviewed retrospectively to identify whether cases had undergone ultrasound. Intraoperative findings and ultrasound reports were compared.Results: 49 cases of Achilles tendon rupture were diagnosed and treated operatively. 23 cases underwent ultrasound of the tendoachilles preoperatively. 8 were reported as partial ruptures. All cases were found to be complete rupture intraoperatively. The sensitivity of ultrasound in establishing completeness of tendoachilles rupture is 63.5%.Conclusion: Ultrasound differentiation of complete vs partial ruptures is not a useful differentiator.

All-inside endoscopic semiautomatic running locked stitch technique shows favourable outcomes for acute Achilles tendon ruptures.

The safety and reliability of endoscopic Achilles tendon rupture repair are still concerning aspects. This study's aim is to evaluate an all-inside endoscopic semiautomatic running locked stitch (Endo-SARLS) technique. Forty cases with acute Achilles tendon rupture were treated with the all-inside Endo-SARLS technique between 2020 and 2021. Under endoscopic control, the proximal tendon stumps were stitched with the running locked method using a semiautomatic flexible suture passer. The threads of the high-strength suture were grasped through the paratenon subspace and then fixed into calcaneal insertion with a knotless anchor. Magnetic resonance imaging (MRI), surgical timeand complications were assessed. Achilles Tendon Total Rupture Score (ATRS), Achilles Tendon Resting Angle (ATRA)and Heel Rise Height Scale (HRHS) were utilised to evaluate final outcomes. The average follow-up time was 25.4 ± 0.4 (range: 24-32) months. Appropriate tendon regeneration was observed on MRI after 12 months. At the final follow-up, the median value of ATRS score was 95 (interquartile range: 94, 98). Furthermore, there is no significant difference between the injured and contralateral side in the average ATRA (18.2 ± 1.8 vs. 18.3 ± 1.9°, ns) and median value of HRHS [14.5 (13.3, 15.5) vs. 14.8 (13.5, 15.6) cm, ns]. No infection and nerve injuries were encountered. Thirty-ninepatients reported that they resumed casual sports activity after 6 months. One patient had a slight anchor cut-out, due to an addition injury, which was removed after 5 months. An all-inside Endo-SARLS technique showed promising clinical results for acute Achilles tendon ruptures. This procedure reduces the risk of sural nerve injuries while establishing a reliable connection between the tendon stumps. Level IV.

Performance Differences in Elite National Basketball Association and Women's National Basketball Association Players Based Upon Whether the Dominant or Non-dominant Achilles Tendon Was Ruptured.

Background National Basketball Association (NBA) and Women's National Basketball Association (WNBA) players with Achilles tendon ruptures have previously been noted to have a significant decline in performance post-injury. There has been recent anecdotal evidence that elite players with dominant Achilles tendon ruptures may be able to return at a higher level of play post-rupture. Objective This study aimed to evaluate for any differences in performance in higher-performing NBA and WNBA players with dominant versus non-dominant Achilles tendon ruptures pre- and post-injury. Methods This study was conducted at the University of Pennsylvania, Department of Physical Medicine and Rehabilitation. NBA and WNBA players with an Achilles tendon rupture from 1990 to 2020 were identified. Only elite players, indicated by an average player efficiency rating (PER) of >15 in either of the three seasons pre/post-injury, were included. The average PER, offensive rating, defensive rating, and usage percentage were compared in the three seasons pre- and post-injury. Results Eighteen players met the inclusion criteria, and nine each were classified as dominant and non-dominant Achilles tendon ruptures based on their primary shooting hand. There was no significant difference between the dominant and non-dominant rupture groups in any outcomes pre-injury, including age. The non-dominant cohort had a significant decline in PER (20.04 vs. 14.16; p < 0.001) and offensive rating (110.33 vs. 101.56; p = 0.004) post-injury. There was no significant difference observed post-injury in defensive rating or usage percentage. The dominant cohort had no significant difference in any outcomes post-injury, returning to the same level of play as pre-injury. Despite no difference existing between the groups at baseline, the dominant group performed significantly better post-rupture with regardto PER (19.56 vs. 14.16; p < 0.001) and offensive rating (114.00 vs. 101.56; p < 0.001) versus the non-dominant group. Conclusion Elite NBA and WNBA players with dominant Achilles tendon ruptures had no change in performance post-injury, returning to the same level of production as pre-injury. Post-rupture, they demonstrated notably superior outcomes versus the non-dominant group with regardto PER and offensive rating. The non-dominant rupture group experienced the same decline in PER and offensive rating post-injury observed in previous studies. The data indicatethat elite NBA and WNBA players with a dominant Achilles tendon rupture have a much more favorable recovery post-injury and are able to return to thesame level of performance.

A Comparative Analysis of Outcomes using PROMIS after Operative vs Non-operative Treatment of Achilles Rupture

Introduction/Purpose: Achilles tendon rupture is a common injury in the adult population. The role of operative and non- operative management remains controversial with the development of functional rehabilitation programs. The purpose of this study is to evaluate and compare the patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and non-operative treatment of acute Achilles rupture. PROMIS is a valid, reliable, and effective tool to evaluate patient outcomes after treatment for Achilles ruptures. Our hypothesis is that there is no significant difference in PROMIS scores between patients undergoing operative compared to non-operative treatment of Achilles rupture. Methods: Under an IRB-approved protocol, Achilles rupture was identified using ICD 9 and ICD10 codes of 727.67 and S86.0. Patients who underwent Achilles tendon primary repair were identified using CPT code 27650 (Repair, primary open or percutaneous, ruptured Achilles tendon). Revision Achilles repair and chronic Achilles ruptures were excluded. All patients treated non-operative underwent a strict functional rehabilitation protocol. We included patients treated between 1/1/2015 and 11/30/2022. PROMIS physical function (PF), pain interference (PI), and depression scores were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method used to determine the minimal clinically important difference (MCID), which was 1/2 standard deviation of each PROMIS domain. A medical records review was performed to collect patient demographic data. Statistical analysis was used to compare preoperative and postoperative scores and significance was indicated when P&lt; 0.05. Results: 216 patients with Achilles tendon ruptured were included (115 Nonoperative versus 101 Operative). Patients treated non-operatively were older than those treated surgically (mean age: 45.1 vs 35.6; p&lt; 0.001). The operative group had a lower BMI compared to non-operative group (27.8 vs. 29.5; p=0.004). There is no statistical difference in the Achilles tendon re-rupture rate between both groups (operative: 2% vs. 4.3%; p=0.344). Both groups are effective in improving PROMIS PF, PI, and depression scores (p &lt; 0.001). The mean PROMIS PF change (pre- to post-treatment) is significantly greater in the operative, compared to the non-operative group (13.2 vs. 9.5; p=0.042). Both treatments had similar mean PROMIS PI change, mean PROMIS depression change, and rates of meeting MCID for all 3 PROMIS domains at 6 months. Conclusion: In patients with Achilles tendon rupture, operative management may lead to statistically significant higher improvements in physical function compared to non-operative management. However, non-operative management was associated with similar overall rates of re-rupture, PROMIS PI and depression outcomes, and chances of meeting MCID as those who underwent operative intervention. Nonoperative management of Achilles tendon rupture, similar to operative treatment, is a successful treatment option and leads to significant improvement in physical function, pain interference, and depression PROMIS scores.

Hyperuricemia as an independent risk factor for achilles tendon rupture in male: a case–control study

ObjectiveTo study the correlation between achilles tendon rupture (ATR) and hyperuricemia, also verify the known risk factors for ATR.MethodsA retrospective review of 488 subjects was performed (182 with Achilles tendon rupture, 306 controls with ankle sprains). Demographic variables and risk factors for rupture were tabulated and compared. The baseline data and related indicators were compared, and the risk factors of ATR were analyzed by constructing a binary logistic regression model.ResultsUnivariate logistic analysis showed that BMI, smoking, and hyperuricemia were risk factors for the development of ATR (OR = 1.65, 95%CI 1.13–2.42, P = 0.01; OR = 1.47, 95%CI 1.00–2.24, P < 0.05; OR = 2.85, 95%CI 1.84–4.42, P < 0.01). Multifactorial analysis showed that BMI ≥ 25 kg/m2, smoking, and hyperuricemia were independent risk factors for the development of ATR (OR = 1.66, 95%CI 1.11–2.49, P = 0.01; OR = 2.15, 95%CI 1.28–3.60, P < 0.01; OR = 3.06, 95%CI 1.92–4.89, P < 0.01). Among the blood biochemical indicators, total cholesterol (TC) and uric acid (UA) were independent risk factors for the occurrence of ATR (OR = 1.54, 95% CI 1.12–2.12, P = 0.01; OR = 1.01, 95% CI 1.01–1.01, P < 0.01).ConclusionOur study confirmed that, as in previous results, higher BMI, smoking, and total cholesterol are risk factors for ATR, Hyperuricemia may contribute to the development of ATR, and adjunctive tests for TC and UA in the blood biochemistry may be helpful in predicting the risk of ATR.

Auditing the Representation of Female Athletes in Sports Medicine Research: Achilles Repair.

Establishing evidence-based recommendations specific to female athletes has been overlooked in sports medicine. Achilles tendon rupture is one of the most common musculoskeletal injuries, occurring in 15 to 55 per 100 000 people annually. Differences in injury rates could be due to hormonal effects, as estrogen receptors have been identified in tendons along with decreased tendon strain based on oral contraceptive use. The primary purpose of this study was to audit the representation of female athletes in the literature regarding Achilles repair. An electronic search was performed using PubMed to identify articles related to Achilles repair using the protocol by Smith et al. Studies were assessed by population, size, athletic caliber, study impact, research theme, and menstrual status. Female representation across all studies was 1783 of 10 673 subjects (16.7%). Composition of included studies was predominantly mixed-sex cohorts with 131 of 169 (77.5%) included studies. Within mixed-sex cohort studies, the total representation of female athletes was 1654 of 8792 participants (18.9%). Thirty-two studies were male only, constituting 1540 participants, whereas 3 studies were female only composed of 86 athletes. Importantly, the disparity between male and female representation worsened as the athletic caliber of the study population increased, with 5.0% female representation in studies with professional athletes. No study collected data related to menstrual status and its potential relationship to Achilles rupture or postoperative outcomes. Mixed-sex cohort studies underrepresented female athletes, and male-only cohort studies were more common than female-only studies. These findings indicate a need for increased representation of female athletes as well as acknowledgment of menstrual status in research related to Achilles repair. Future studies should focus on representation of female athletes and data collection related to sex-specific hormones, hormonal contraceptive use, and menstrual status to improve treatment of Achilles tendon ruptures for female athletes. Level IV, case series.

Evaluation of Surgical Costs in Acute Achilles Repairs

Introduction/Purpose: Increasing attention is being paid to the costs associated with various orthopedic surgeries. Here, we studied the factors that influence costs associated with surgically treated acute Achilles tendon tears. Methods: We retrospectively identified patients with surgically repaired acute Achilles tendon tears, excluding insertional ruptures or chronic tendon issues. Using the Value Driven Outcome (VDO) tool from our institution, we assessed total direct costs as well as facility costs. Briefly, the VDO tool includes an item-level database that can capture granular-level cost data – costs are then reported as relative mean data. Cost variables were adjusted to 2022 US dollars, and total direct cost was compared with patient characteristics using gamma regressions to report cost ratios with 95% confidence intervals (CIs). Results: Our cohort consisted of 224 patients with Achilles tendon tears surgically repaired by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographics, total direct costs, or facility costs based on positioning (prone N =156, supine N =68). Total direct costs were 9% higher in males (N =182) compared to females (N =42) (p=0.023, 95% CI: 1.01-1.17) in an unadjusted analysis. Mini-open repairs (N =215), compared to percutaneous techniques (N =9), had 32% less total direct costs (p &lt; 0.001; 95% CI: 0.60-0.78). Compared to surgery at a main academic hospital (N =15), procedures at an ambulatory care center (N =207) had 25% lower total direct costs (p &lt; 0.001; 95% CI: 0.67-0.83) and 44% lower reduced facility costs (p &lt; 0.001; 95% CI: 0.51-0.61). Significance was maintained in multivariable analysis except for sex. Conclusion: Improving cost-effective orthopedic care remains an increasingly important goal. Patient positioning for Achilles tendon repair does not appear to have meaningful effects on cost. Surgery at an ambulatory center was significantly less costly than repairs performed at an academic hospital. When clinically appropriate, considering surgery location at an ambulatory center appears to reduce surgical costs.

Achilles tendon rupture primary repair technique: A comparative retrospective study between graft versus no-graft

IntroductionAchilles tendon rupture is one of the most common musculoskeletal injuries and accounts to 20 % of all large tendon ruptures The surgical choice of a procedure might play a role in the incidence of postoperative complications. This study aimed to estimate and compare the incidence of complications occurring within a 30-day window following primary surgical repair of the Achilles tendon with or without a graft. MethodsA retrospective cohort study was conducted using the ACS NSQIP database from 2005 to 2021. Patients were divided into 2 cohorts (primary surgical repair with and without graft). ResultsA total of 7010 patients were included in the analysis. Among the graft group, 10.9 % reported any complication which was double the percentage of complications in the no graft group. Only 3.8 % of the no graft patients had reported systemic complications compared to 8.3 % in the graft group. Chronic steroid use was found to be an effect modifier in the incidence of any complications after primary surgical repair when comparing graft versus no graft (P-value 0.016). ConclusionSurgical repairwith tendon graft develops more complications than repairing without graft. Therefore, it is imperative for physicians to strive for an early diagnosis, as any delay in treatment significantly raises the likelihood of complications. Levels of evidenceIII, Retrospective Cohort Study.

Salvage Reconstruction of a 12-cm Tendon Defect Following Chronic Achilles Rerupture-15-Year Follow-Up: A Case Report.

A 39-year-old man with a chronic Achilles rupture status post (1) failed primary repair and (2) secondary xenograft repair with graft rejection, resulting in a 12-cm Achilles tendon defect, which was reconstructed utilizing an Achilles bone block allograft and flexor hallucis longus (FHL) tendon transfer. At 15-year follow-up, the patient reported good functionality and satisfaction with the repair, with positive patient-reported outcome measures. Physical examination revealed excellent strength and range of motion. Magnetic resonance imaging confirmed the integrity and incorporation of the Achilles/FHL graft composite. This case study provides valuable insight into successful long-term management of complex chronic Achilles ruptures with large defects.

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]

Modified Surgical Treatment for Achilles Tendon Rupture Secondary to Insertional Achilles Tendinopathy Using Midline Dorsal Approach

Objective: To assess the pain relief and functional outcomes of patients who undergo surgical management of Achilles tendon rupture secondary to insertional Achilles tendinopathy and associated conditions using a midline dorsal approach.Methods: This prospective observational study included 30 patients diagnosed with Achilles tendon rupture secondary to insertional Achilles tendinopathy. We recorded risk factors, predisposing factors, and co-morbidities for all cases. Pain relief and functional improvement were assessed by comparing Visual Analogue Scale (VAS) scores and American Orthopedic Foot and Ankle Score (AOFAS) at the time of presentation and at the final follow-up. We conducted statistical analysis using SPSS 21.0 software, with a significance level of p&lt;0.05.Results: Of the participants, 17 (56.67%) were male and 13 (43.13%) were female, resulting in a male-to-female ratio of 1:0.76. The mean age of male and female patients was comparable (p=0.7515). The majority of patients (60%) were overweight, while 9 (30%) were obese, and 3 (10%) had a normal body mass index. We observed a significant reduction in pain and functional improvement in the studied cases, as evidenced by a statistically significant reduction in VAS scores and improvements in AOFAS. Eight (26.66%) patients experienced minor complications that could be managed conservatively, but no major complications were observed.Conclusion: Modified surgical treatment of Achilles tendon rupture secondary to insertional Achilles tendinopathy using a midline dorsal approach leads to significant improvements in pain and functional outcomes, with an acceptable complication rate.

CXCL13-neutralizing Antibody Alleviate Chronic Skeletal Muscle Degeneration in a Mouse Model.

Skeletal muscle degeneration is a common effect of chronic muscle injuries, including fibrosis and fatty infiltration, which is the replacement of preexisting parenchymal tissue by extracellular matrix proteins and abnormal invasive growth of fibroblasts and adipocytes. This remodeling limits muscle function and strength, eventually leading to reduced quality of life for those affected. Chemokines play a major role in the regulation of immunocyte migration, inflammation, and tissue remodeling and are implicated in various fibrotic and degenerative diseases. In this study, we aimed to investigate the role of the B-cell chemokine CXCL13 in the gastrocnemius muscle of the Achilles tendon rupture model mouse. We hypothesize that CXCL13 may promote fibrosis and aggravate skeletal muscle degeneration. We performed RNA sequencing and bioinformatics analysis of gastrocnemius muscle from normal and model mice to identify differentially expressed genes and signal pathways related to skeletal muscle degeneration and fibrosis. Our results show that CXCL13 is highly expressed in chronically degenerating skeletal muscle. Furthermore, CXCL13-neutralising antibodies with therapeutic potential were observed to inhibit fibrosis and adipogenesis in vivo and in vitro. Our study reveals the underlying therapeutic implications of CXCL13 inhibition for clinical intervention in skeletal muscle degeneration, thereby improving patient prognosis.