Achilles Tendon Rupture Research Articles

Prognosis of Nonconcurrent Bilateral Achilles Tendon Rupture Is Worse Than Unilateral Achilles Tendon Rupture: Patient-Reported Outcomes at Minimum 2-Year Follow-up.

Approximately 5%-7% of patients who have had Achilles tendon rupture (ATR) suffer from contralateral ATR. However, no studies have evaluated the clinical outcomes of contralateral ATR in patients with an existing ATR. Therefore, in this study, we aimed to investigate patient-reported ankle function and activity levels in patients with nonconcurrent bilateral ATR. We retrospectively reviewed the data of 222 patients with an acute ATR who presented at our 2 institutions between 2005 and 2017. All patients had a minimum 2-year follow-up period, with no other major injuries to the ankle joint. Of these patients, 17 patients had nonconcurrent bilateral ATR. Patient-reported outcomes were assessed by telephone interview, using the Achilles tendon Total Rupture Score (ATRS), the ankle activity score, and a patient satisfaction questionnaire. Telephonic interviews were conducted by 2 authors, using a prepared script to minimize bias owing to individual interviewers. The mean age of the patients was 45.1 ± 9.8 years, and 89% were men. Patients with nonconcurrent bilateral ATR had significantly lower values in terms of ATRS, ankle activity score, and satisfaction with current activity level, compared to patients who had unilateral ATR (p < 0.001, p = 0.027, and p = 0.012, respectively). Patients with nonconcurrent bilateral ATR had poorer ankle function, activity levels, and satisfaction than those with unilateral ATR in terms of patient-reported outcome measures with an intermediate-term result and a 2-year minimum follow-up period. These results emphasize the importance of the impact of contralateral injury on the prognosis of patients with ATR and the need for efforts to prevent contralateral rupture.

Differences in Player Performance and Longevity After Achilles Tendon Rupture Between Professional Basketball Players in the NBA and WNBA.

Prior studies in the National Basketball Association (NBA) and Women's National Basketball Association (WNBA) reported worse player performance after Achilles tendon rupture (ATR). The purpose of this study was to compare time to return to play (RTP) and performance after ATR between NBA and WNBA athletes. It was hypothesized that there would be no relative difference between the NBA and WNBA players. Cohort study; Level of evidence, 3. ATRs in the NBA between 1987 and 2017 and WNBA between 2006 and 2017 were identified through a rigorous online search of articles. Included athletes had no prior leg injuries and had played ≥3 seasons before and after ATR. Sex, age, position, body mass index, height, years of experience, time to RTP, and player efficiency rating (PER) were recorded. Relative performance was measured by matching injured athletes to uninjured controls in the same league in a 1:2 ratio. Relative differences were compared between leagues, with adjustment for baseline features. Multiple regression analysis was employed to identify variables correlating with RTP and PER. Included were 102 professional basketball players, of whom 34 sustained ATR (21 male, 13 female). Sex/league correlated with differences in RTP (P < .001). There was a significant difference between the WNBA and NBA in PER when comparing 1 year pre- and 1 year postinjury (1.49 ± 0.25 vs 3.87 ± 0.43, respectively; mean ± SD P < .001). Compared with intraleague controls, the relative difference in PER postinjury was 0.81 ± 0.11 (WNBA) and 3.9 ± 0.89 (NBA) (P < .001). Multiple regression analysis indicated that when controlling for years of experience, player position, and age, NBA players took 126 days longer than WNBA players to RTP (P < .001) and NBA players had 9.96 times increased odds of taking >200 days to RTP compared with WNBA players (P = .006). Sex/league was a significant predictor of RTP after ATR. When compared with their respective controls, NBA players saw a greater decrease in postinjury performance than WNBA players. NBA players took longer to RTP than WNBA players. ATRs appear to more negatively affect NBA players than WNBA players.

Achilles Tendon Ruptures in National Hockey League Players: Return to Sport and Performance Impact.

Few studies assess rates of return to play and postinjury performance in National Hockey League (NHL) players who sustain Achilles tendon ruptures. Our objective was to determine the rate of return to play and performance impact among NHL players who undergo surgical repair of Achilles tendon tears. NHL players who sustained an Achilles tendon rupture between 2001 and 2021 were identified using a publicly available injury database. Demographic and outcome data were collected for the 1-year period preceding and the 2-year period following surgery. Our primary outcome was expected wins above replacement per 60 minutes played. A position, draft year, and index season performance matched cohort was created. Pre- and postinjury outcomes were compared between cases and controls with a paired t test. We identified 15 cases (9 forwards, 5 defencemen, 1 goaltender). Fourteen of 15 (93%) players returned to play. Preinjury, postinjury year 1, and postinjury year 2 expected wins above replacement were 0.05, 0.05, 0.05 respectively (P > .05). There was no significant difference in performance between cases and controls at any time point. Achilles tendon tears are associated with a high rate of return to play in the NHL and are not associated with a significant change in offensive, defensive, or overall performance-based metrics. Level III, case-control study.

The Difference in Achilles Tendon Loading within Immobilizing Boots Based on Ankle Angle, Boot Type, and Walking Speed.

Achilles tendon rupture is an increasingly common injury treated with progressive rehabilitation in an immobilizing boot. However, it is poorly understood how ankle angle, boot type, and walking speed affect Achilles tendon loading. These different parameters would affect Achilles tendon loading in terms of (from greatest to least) ankle angle constraint, immobilization style, boot construction, and walking speed. Descriptive laboratory study. Ten healthy young adults (8 women and 2 men; age, 21 ± 2 years; body mass index, 21.5 ± 3.0 kg/m2) walked in 3 different immobilizing boots at self-selected slow, medium, and fast walking speeds. The authors estimated Achilles tendon loading using a 3-part instrumented insole within the immobilizing boot. The authors averaged tendon load across every stride for each condition and calculated 2-sided bootstrap confidence intervals. Peak tendon loading was compared across all boots, ankle angles, and walking speeds. All boots and immobilization styles decreased tendon loading with respect to shod walking. Immobilization angle had the largest effect on tendon loading, followed by boot construction, and finally walking speed. Ankle angle, boot type, and walking speed can be modified to change loading progression during rehabilitation. Understanding how immobilization affects tendon loading will enable clinicians to modify rehabilitation to improve functional outcomes.

Does free tendon length influence the injury risk of the Achilles tendon? A finite element study

ABSTRACTPurposeThe Achilles tendon is a common injury site, but anatomical risk factors for injury are relatively unexplored in the literature. This study aimed to evaluate whether changes in free tendon length would influence the results of a simulated rupture of the Achilles tendon.MethodsUsing a previously validated 3D finite element model of the free and aponeurotic Achilles tendon as a basis, two additional finite element models with 25% decreased and increased free tendon lengths were created. The finite element models were sequentially loaded from 2500 to 3500N in 100N increments, and the total volume of elements exhibiting a maximal principal strain above 10% was recorded. An Achilles tendon rupture was considered to have occurred when a continuous group of elements with a volume of at least 3 mm3 exhibited a maximum principal strain above 10%. Models were compared regarding the smallest load that met the rupture criterion and plots of the percentage of elements exhibiting maximum principal strains above 10% across the loading range. Sensitivity analyses assessed the influence of subtendon division variations and subtendon sliding restriction on the results.ResultsRupture loads and plots of the percentage of elements with maximum principal strains above 10% were similar between models, regardless of the free tendon length. No models met the rupture criterion when simulations were run without subtendon sliding. Rupture loads in the subtendon division variation models were correlated with the subtendon cross‐sectional areas.ConclusionsThe simulated rupture results of the Achilles tendon were sensitive to variations in subtendon cross‐sectional areas but not in free tendon length.Level of EvidenceLevel V.

Fear of reinjury after acute Achilles tendon rupture is related to poorer recovery and lower physical activity postinjury.

The aim of this study was to investigate how fear of reinjury to the Achilles tendon affects return to previous levels of physical activity and self-reported Achilles tendon Total Rupture Score (ATRS) outcomes. Data were collected from a large cohort of patients treated for an acute Achilles tendon rupture at Sahlgrenska University Hospital Mölndal between 2015 and 2020. The ATRS and additional questions concerning fear of reinjury, treatment modality, satisfaction of treatment and recovery were analyzed 1-6 years postinjury. Analysis was performed to determine the impact of fear of reinjury on patient-reported recovery and physical activity. Of a total of 856 eligible patients, 550 (64%) answered the self-reported questionnaire and participated in the follow-up. Of the participants, 425 (77%) were men and 125 (23%) were women. ATRS, recovery in percentage, satisfaction of treatment, recovery on a 5-point scale and physical activity level post- versus preinjury were significantly related to fear of reinjury (p < 0.001). Of the nonsurgically treated patients, 59% reported fear of reinjury compared to 48% of the surgically treated patients (p = 0.024) Patients that reported fear of reinjury had a 15-point lower median ATRS score than those who did not (p < 0.001). More than half of patients who have suffered an Achilles tendon rupture are afraid of reinjuring their tendon. Patients who reported fear of reinjury exhibited a significantly lower ATRS score. This indicates the importance of addressing psychological aspects in the treatment after this injury. Level II.

H-Loop Knotless Double-Row Repair Versus Krackow Repair for Achilles Tendon Rupture: A Biomechanical Study in a Cadaveric Model.

Surgery is widely recognized as an effective treatment for Achilles tendon rupture; however, there remains debate regarding the optimal surgical approach. To compare the biomechanical properties of 2 techniques, the H-loop knotless double-row (HLDR) suture repair and the Krackow suture repair, for Achilles tendon rupture in a cadaveric model. Controlled laboratory study. Ten matched Achilles tendon specimens from 5 male and 5 female donors were obtained. Each specimen from a matched pair was randomly distributed to 1 of 2 repair groups, the HLDR group or the Krackow group. Tendon elongation was recorded after exposure to 10, 100, 200, 400, 600, 800, and 1000 load cycles. The gap distance after application of a 100-N force, the force needed to produce a 2-mm gap, and the load to failure were measured. All biomechanical properties were compared between the HLDR and Krackow groups using the paired t test. The HLDR group consistently exhibited significantly less elongation than the Krackow group after exposure to the 7 load cycles (P < .01 for all). In addition, the HLDR group exhibited a significantly smaller gap distance after applying a 100-N force (0.30 ± 0.02 vs 8.10 ± 0.46 mm for Krackow group), required significantly more force to generate a 2-mm gap (419.68 ± 39.48 vs 22.29 ± 3.40 N for the Krackow group), and had a significantly higher ultimate failure load (519.91 ± 57.29 vs 220.30 ± 19.27 N for the Krackow group) (P < .01 for all). The study findings demonstrated that the HLDR technique had more advantages compared with the Krackow technique with regard to elongation after different cyclic loadings, gap distance after a 100-N load, force needed to produce a 2-mm gap, and load to failure in a cadaveric model. The HLDR technique could be a viable option for Achilles tendon rupture repair.

Trimalleolar Fracture Associated with Subcutaneous Rupture of the Achilles Tendon and Traumatic Peroneal Dislocation: A Case Report and Review of the Literature.

We report the case of a 44-year-old man who sustained an Achilles tendon rupture with an associated trimalleolar fracture and traumatic peroneal dislocation of the left ankle after a snowboarding injury. These injuries have been surgically repaired; the patient has returned to all his activities 18 months after surgery. The possibility of such injuries occurring in combination should be considered. A thorough history, physical examination, and plain radiographs should be performed in higher energy trauma to the ankle. Additional diagnostic tests such as ultrasonography or magnetic resonance imaging may be used to supplement treatment. Level 5.

Prevention Of Achilles Tendon Ruptures In Female Gymnasts By NSAIDs And Maintenance Of Floor Equipment

Prevention Of Achilles Tendon Ruptures In Female Gymnasts By NSAIDs And Maintenance Of Floor Equipment

Open versus Percutaneous Repair of Acute Achilles Tendon Rupture A Systematic Review

Abstract Background The optimal treatment of acute Achilles tendon ruptures (AATR) is still under debate. It is most frequently ruptured in the 3rd and 4th decade of age. Objective The aim of this study was to compare open repair and minimally invasive repair in acute Achilles tendon rupture in adults regarding operative techniques, functional outcome and complications. Patients and Methods This systematic review included 6 articles with 329 patients. There were 165 patients had open repair and 164 patients by percutaneous repair with a mean follow-up of 23 months (range 20–24 months). Variables of each article were recorded and analyzed with respect to age, sex, follow-up, complications, and final outcomes. Results Percutaneous technique was much faster than open repair but regarding time to return to work, open repair patients had fewer weeks than the percutaneous. Complications were less in percutaneous repair except sural nerve injury. Conclusion The review has showed out that minimally invasive techniques clinically and biomechanically suitable alternatives to open repair based on both clinical outcomes and complication.

Refractory Nephrotic Syndrome Resulting in Bilateral Achilles Tendon Rupture Due to Relapse by Vaccination after Recovery from COVID-19: A Case Report

Refractory Nephrotic Syndrome Resulting in Bilateral Achilles Tendon Rupture Due to Relapse by Vaccination after Recovery from COVID-19: A Case Report

The Impact of Social Determinants of Health on Management of a Full Thickness Achilles Tendon Rupture

The Impact of Social Determinants of Health on Management of a Full Thickness Achilles Tendon Rupture

Panda Rope Bridge Technique promoted Achilles tendon regeneration in a novel rat tendon defect model.

This study aimed to determine whether the Achilles tendon tissue can undergo the pathological process of Achilles tendon regeneration after the Panda Rope Bridge Technique (PRBT). Rats (n = 120) that operated with Achilles tendon rupture were divided into three treatment groups: Defect group (D group), PRBT group and Defect + Fix group (DF group). The D group represented natural healing with no treatment, the PRBT group represented healing receiving PRBT treatment and the DF group represented healing through conservative treatment by ankle fixation. The morphological, histological and biomechanical properties of the defective Achilles tendon were assessed at 7, 10, 12, 14, 28 and 56 days postoperatively. Compared to that observed in the other two groups, defected rat Achilles tendons that underwent PRBT recruited more cells earlier, eventually forming mature tendons, as revealed by histological analysis. PRBT also enabled defected tendons to regain stronger mechanical properties, thereby improving the prognosis. This improvement may be related to the earlier polarization of macrophages. By establishing and using a novel surgical model of Achilles tendon rupture in rats, most injured Achilles tendons can regenerate and regain normal histological properties, whereas tendons with other interventions formed fibrotic scar tissue. The strong regenerative capacity of tendon tissue enabled us to describe the pathological process of tendon regeneration after PRBT surgery in detail, which would aid in the treatment of tendon injuries. PRBT promotes Achilles tendon regeneration and has the potential to become a standard treatment. Not applicable.

The Effectiveness of the Modified Side-Locking Loop Suture Technique with Early Accelerated Rehabilitation for Acute Achilles Tendon Rupture in Athletes

Background/Objectives: An early accelerated rehabilitation is generally recommended after surgery for acute Achilles tendon ruptures (ATRs). The modified side-locking loop suture (MSLLS) is a surgical technique that provides high tensile strength to the repaired Achilles tendon and allows for a safe, early accelerated rehabilitation protocol without requiring postoperative immobilization. However, there are no reports investigating the clinical outcomes of the MSLLS technique with early accelerated rehabilitation for ATRs. To clarify the effectiveness of the MSLLS technique with an early accelerated rehabilitation protocol for ATR in athletes. Methods: We retrospectively analyzed 27 athletes (Tegner activity score ≥ 6) who underwent surgical treatment using the MSLLS technique for ATR between April 2017 and August 2022. All patients underwent an early accelerated rehabilitation protocol without immobilization. Outcome measures included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score taken preoperatively and one year postoperatively, the time required to perform 20 continuous double-leg heel raises (DHR) and single-leg heel raises (SHR), the time to return to the original sport, and the presence of any complications. Results: The mean AOFAS score significantly improved from 37.2 ± 9.7 preoperatively to 96.3 ± 5.3 one year postoperatively. The mean time to be able to perform 20 continuous DHR and SHR was 7.7 ± 1.2 weeks and 11.3 ± 1.6 weeks, respectively. All patients were able to return to their original sport at their pre-injury level in an average of 22.7 ± 3.7 weeks without complication. Conclusions: The MSLLS technique in conjunction with an early accelerated rehabilitation protocol for ATR in athletes produced satisfactory results, with all patients able to return to their original sport at their preinjury level without complication.

The Functional Outcome of Boswarth Technique in terms of Ability to Stand on Tip Toes of Affected Side and Power of Planter Flexion

Background: Bosworth healed an Achilles tendon rupture by wrapping a wide strip of the proximal aponeuros is around the proximal and distal tendon stumps. Objective: To find out the functional outcome of Boswarth Technique in terms of ability to stand on tip toes of affected side and power of planter flexion. Methodology: DMCH conducted this prospective research from July 2006 to December 2007. Non-randomized purposive sampling chose 20 DMCHF outpatients.18 patients were first studied. Data was hand-edited. After that, SPSS data was entered. Results: The youngest patient was 17 years old and the oldest 47 years old.5:1 male-female ratio. Nearly 40% of patients were injured by an overhanging toilet pan, 27.8% by traumatic rupture, and 11.1% by a sharp weapon. The median injury level was 3.5 cm above the tendoachilles insertion, whereas the lowest and highest were 2.5 and 6 cm. Objective examination shows 45% of patients had excellent functional outcomes, 38.9% good, 11.1% fair, and 5.6% poor. This study's results were good in 83.3% and unsatisfactory in 16.7%. Conclusion: The Bosworth approach was simple to learn, making it potentially appropriate for foot and ankle surgeons with less training.

Transverse small incision intrathecal "loop" minimally invasive suture for treatment of acute Achilles tendon rupture

To evaluate the effectiveness and feasibility of a transverse small incision intrathecal "loop" minimally invasive suture for acute Achilles tendon rupture. The clinical data of 30 patients with acute Achilles tendon rupture treated with transverse small incision intrathecal "loop" minimally invasive suture between January 2022 and October 2023 was retrospectively analyzed. The patients were all male, aged from 29 to 51 years, with an average of 39.8 years. The cause of injury was acute sports injury, and the time from injury to operation was 1-14 days, with an average of 3.4 days. The operation time, incision length, intraoperative blood loss, intraoperative complications, wound healing, and hospital stay were recorded. Postoperative appearance and function of ankle were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Vancouver Scar Scale (VSS) score, and Arner-Lindholm score. The operation time ranged from 30 to 90 minutes, with an average of 54.2 minutes; the incision length ranged from 1.3 to 3.5 cm, with an average of 2.2 cm; the intraoperative blood loss ranged from 5 to 70 mL, with an average of 22.3 mL; and the hospital stay ranged from 2 to 6 days, with an average of 3.7 days. All incisions healed by first intention, and there was no incision infection, poor healing, and deep venous thrombosis. All patients were followed up 5.3-22.0 months (mean, 14.7 months). During the follow-up, all the 30 patients had returned to exercise, and there was no complication such as Achilles tendon re-rupture, postoperative infection, and gastrocnemius muscle injury. At last follow-up, the AOFAS ankle-hindfoot score was 82-100, with an average of 95.1; the VSS score was 1-4, with an average of 2.1; according to the Arner-Lindholm score, 24 cases were rated as excellent and 6 cases as good. Transverse small incision intrathecal "loop" minimally invasive suture for the treatment of acute Achilles tendon rupture has the advantages of simple instrument, convenient operation, small trauma, quick recovery, and satisfactory effectiveness.

Update on minimally-invasive treatment of Achilles tendon rupture

Percutaneous and minimally invasive suturing techniques are very important in the treatment of acute Achilles tendon ruptures because they combine the advantages of surgical treatment (low re-rupture rate) and non-opervative treatment (low risk of complications). In the authors' approach, the percutaneous, peritendineum-preserving technique with the Dresden instrument has proven itself as astandard treatment for 20years. Strict adherence to the original Dresden technique with posteromedial incision and subfascial preparation is crucial for the safe avoidance of the sural lesions regularly reported in percutaneous procedures. The rupture zone and the peritendineum should not be opened. By adding athird suture and using non-absorbable suture material, stability comparable to the open Krackow suture technique is achieved. Functional aftertreatment with protection in aspecial boot and appropriate supervision of the patient aims at early rehabilitation while minimizing the risk of re-rupture or loss of tension. The focus of future efforts should be to further improve treatment results through individualized postoperative treatment adapted to tendon healing.

Treatment of chronic ruptures and defects of the Achilles tendon

Achilles tendon ruptures that are older than 4-6weeks or developed over amore extended period are chronic. Two challenges characterize the treatment. First, defect zones over alength of several centimeters must frequently be bridged. Second, aprolonged loss of function of the muscles leads to an irreversible fatty degeneration of the tissue. So that even if the tendon is restored, significant functional deficits remain. If there are doubts about the ability of the calf muscles to regenerate, regardless of the size of the defect, tendon transfers are recommended to use the power of an additional muscle to support the plantar flexion of the ankle. Established concepts are the transposition of the flexor hallucis longus or the peroneus brevis muscle. If the muscle is intact, defects of up to 2 cm can be treated with adirect suture. Defects between 2and 5 cm can be bridged using aVY-plasty or aturndown flap. For larger defects, free tendon transplants can be considered. The technical alternative for larger defects is atendon transfer of the flexor hallucis longus or the peroneus brevis muscle. Besides bridging the defect, another advantage of tendon transfer is that vital muscle tissue is placed in the bed of the Achilles tendon. Both tendons are covered with muscle tissue over nearly the full length, which offers advantages, especially in patients with critical soft tissue or after infection. Follow-up treatment is analogous to an acute Achilles tendon rupture. However, permanent impairments are possible; 75-80% of athletes regain their original performance level.

Clinical and biomechanical comparison of suture-external button versus interference screw associated with V-Y advancement or turndown flaps for flexor hallucis longus transfer in chronic Achilles tendon rupture.

Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between two techniques for fixation of flexor hallucis longus tendon to the calcaneus: interference screw and suture-external button. Twenty-five patients participated in this retrospective comparative study. All patients underwent short harvest FHL tendon transfer for chronic AT rupture were asked for a follow-up visit, at least one year following surgery. The outcomes were evaluated by visual analog scale (VAS), AOFAS ankle-hindfoot score, and VISA-A questionnaire. Ankle ROM with possible restriction in addition to isokinetic strength of ankle plantar- and dorsiflexors was assessed. No statistically significant difference was observed between the groups for pain (P = 0.81), AOFAS ankle-hindfoot scale (P = 0.97), and VISA-A (P = 0.44). Notably, more decrease in ankle dorsiflexion was seen in interference screw group in comparison with suture-external button group (4.4 ± 6.6 vs. 9.5 ± 6.1 degrees, P = 0.06). The difference of active dorsiflexion between operated and non-operated side in interference screw group was statistically significant (P = 0.02). Biotenodesis screw imposed more limb asymmetry in comparison with suture-external button technique. Fixation of transcalcaneal FHL tendon transfer for chronic AT either by interference screw or suture-external button has encouraging postoperative clinical results. Although ROM of the ankle joint reduced in both techniques, interference screw may result in more reduction in dorsiflexion of the ankle.

"Dr. AI Will See You Now": How Do ChatGPT-4 Treatment Recommendations Align With Orthopaedic Clinical Practice Guidelines?

Artificial intelligence (AI) is engineered to emulate tasks that have historically required human interaction and intellect, including learning, pattern recognition, decision-making, and problem-solving. Although AI models like ChatGPT-4 have demonstrated satisfactory performance on medical licensing exams, suggesting a potential for supporting medical diagnostics and decision-making, no study of which we are aware has evaluated the ability of these tools to make treatment recommendations when given clinical vignettes and representative medical imaging of common orthopaedic conditions. As AI continues to advance, a thorough understanding of its strengths and limitations is necessary to inform safe and helpful integration into medical practice. (1) What is the concordance between ChatGPT-4-generated treatment recommendations for common orthopaedic conditions with both the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) and an orthopaedic attending physician's treatment plan? (2) In what specific areas do the ChatGPT-4-generated treatment recommendations diverge from the AAOS CPGs? Ten common orthopaedic conditions with associated AAOS CPGs were identified: carpal tunnel syndrome, distal radius fracture, glenohumeral joint osteoarthritis, rotator cuff injury, clavicle fracture, hip fracture, hip osteoarthritis, knee osteoarthritis, ACL injury, and acute Achilles rupture. For each condition, the medical records of 10 deidentified patients managed at our facility were used to construct clinical vignettes that each had an isolated, single diagnosis with adequate clarity. The vignettes also encompassed a range of diagnostic severity to evaluate more thoroughly adherence to the treatment guidelines outlined by the AAOS. These clinical vignettes were presented alongside representative radiographic imaging. The model was prompted to provide a single treatment plan recommendation. Each treatment plan was compared with established AAOS CPGs and to the treatment plan documented by the attending orthopaedic surgeon treating the specific patient. Vignettes where ChatGPT-4 recommendations diverged from CPGs were reviewed to identify patterns of error and summarized. ChatGPT-4 provided treatment recommendations in accordance with the AAOS CPGs in 90% (90 of 100) of clinical vignettes. Concordance between ChatGPT-generated plans and the plan recommended by the treating orthopaedic attending physician was 78% (78 of 100). One hundred percent (30 of 30) of ChatGPT-4 recommendations for fracture vignettes and hip and knee arthritis vignettes matched with CPG recommendations, whereas the model struggled most with recommendations for carpal tunnel syndrome (3 of 10 instances demonstrated discordance). ChatGPT-4 recommendations diverged from AAOS CPGs for three carpal tunnel syndrome vignettes; two ACL injury, rotator cuff injury, and glenohumeral joint osteoarthritis vignettes; as well as one acute Achilles rupture vignette. In these situations, ChatGPT-4 most often struggled to correctly interpret injury severity and progression, incorporate patient factors (such as lifestyle or comorbidities) into decision-making, and recognize a contraindication to surgery. ChatGPT-4 can generate accurate treatment plans aligned with CPGs but can also make mistakes when it is required to integrate multiple patient factors into decision-making and understand disease severity and progression. Physicians must critically assess the full clinical picture when using AI tools to support their decision-making. ChatGPT-4 may be used as an on-demand diagnostic companion, but patient-centered decision-making should continue to remain in the hands of the physician.