Achilles Tendon Rupture Research Articles

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.

Achilles tendon ruptures related to fluoroquinolone use – How can we manage these patients? A case series

BackgroundFluoroquinolone antibiotics can increase the risk of tendon rupture. Treatment of these Achilles ruptures can be difficult due to comorbidities. MethodsA case series of 13 consecutive patients with Achilles ruptures following fluoroquinolone use were identified over a 2 year period through the Achilles Tendon rupture clinic and managed conservatively using functional rehabilitation. Follow-up with the Achilles tendon rupture score (ATRS) was completed at 3 months, 6 months and 12 months. ResultsImprovements were seen in ATRS scores over 12 months. ConclusionsThis case series is the largest published. Improvements were seen in ATRS scores indicating that this cohort can be managed successfully using functional rehabilitation after fluoroquinolone-induced Achilles rupture.

Surgical or non-operative treatment of acute Achilles tendon rupture : What does the current literature say?

The Achilles tendon is the strongest tendon in humans and is frequently injured, especially in the physically active young to middle-aged population. An increasing frequency of Achilles tendon ruptures (ATR) has been reported in several studies. However, there is no international consensus regarding possible non-operative (N-OP) or operative (surgical) treatment (OP). The aim of this article is to semi-quantitatively compare both treatment options for ATR by analyzing the results reported in the literature. For this purpose, relevant categories were identified, and the literature was then evaluated in aPubMed analysis. Tenmeta-analyses and twocost analyses were included. The data was extracted according to the categories and evaluated comparatively. OP and N‑OP for acute ATR can lead to equally good restitution of clinical function if early functional rehabilitation is applied. The lower re-rupture rate is an advantage of OP, whereas the lower general complications speak in favor of N‑OP. The minimally invasive or percutaneous surgical technique (M-OP) appears to be advantageous over the open surgical technique (O-OP), although studies show an increased rate of lesions of the sural nerve. There is no consensus regarding the superiority of OP or N‑OP for acute ATR, as several studies conducted since the introduction of early mobilization protocols have shown similar results for these two interventions. Results and complications of M‑OP and O‑OP are also comparable. Considering the available data on the various surgical procedures, the authors prefer the M‑OP technique with adequate sural nerve protection for repair of acute ATR, combined with an early mobilization protocol.

The effectiveness of low-load Blood flow restriction Exercise in patients with an acute Achilles tendon rupture treated Non-surgically (BEAN): Protocol for a randomized controlled trial

BackgroundBlood flow restriction exercise (BFRE) has been proposed as a viable method for preserving muscle mass and function after an injury during periods of load restrictions such as after an acute Achilles tendon rupture. However, its effectiveness and safety in patients with an Achilles tendon rupture have yet to be evaluated in a randomized trial. ObjectivesFirst, to investigate the effectiveness of early initiated BFRE in patients with non-surgically treated acute Achilles tendon rupture. Second, to evaluate whether it is better to apply BFRE in the beginning (1–12 weeks) or later (13–24 weeks) in the rehabilitation period. MethodsThis is an assessor-blinded, randomized, controlled multicenter trial with patients assigned in a 1:1 ratio to two parallel groups, that either receive BFRE in weeks 1–12 followed by usual care in weeks 13–24, or receive usual care in weeks 1–12 followed by BFRE in weeks 13–24. The BFRE program is performed three times weekly on the injured leg at 80 % of the pressure required to fully restrict the arterial blood flow. Post-intervention tests are conducted in week 13, comparing early BFRE with usual care, and in week 25, comparing early BFRE with late BFRE. At the 13-week evaluation, the primary outcome is the Single-Leg Heel-Rise test which assesses the patient’s ability to raise the heel of the injured leg a minimum of 2 cm. At the 25-week evaluation, the primary outcome is the Achilles tendon Total Rupture Score which assesses the patient’s self-reported symptoms and physical ability.

Оценка болевого синдрома в реабилитационных мероприятиях после операции по поводу разрыва ахиллова сухожилия

INTRODUCTION. Patients who have been injured need an early start of rehabilitation measures. This is due to the fact that prolonged restriction of motor activity, lack of exercise, vascular and other changes lead to muscle atrophy, limited mobility in joints, impaired metabolic processes in the extremities, loss of functional conditions. AIM. To optimize the complex of measures for early rehabilitation after surgery for Achilles tendon rupture, taking into account the assessment of pain syndrome. MATERIAL AND METHODS. The research work was carried out at the Department of Medical Rehabilitation and Sports Medicine. To implement the tasks set, the following stages were introduced: a critical analysis of domestic and foreign sources, the development of an individual rehabilitation plan with an assessment of pain syndrome. RESULTS AND DISCUSSION. For effective rehabilitation in the postoperative period, it is important to objectively control the patient's pain sensations, gradually increasing the load on the damaged tendon. The pain monitoring and weight load dosing scale based on the visual analog scale has found wide application. Visual analog scale consists of a horizontal line on which the extreme points correspond to 0 points (no pain) and 10 points (maximum unbearable pain). The patient marks a point on this line corresponding to his current pain level. The pain syndrome was assessed on the day of surgery, and then on the 7th, 14th, 21st, 35th, 42nd and 49th days of follow-up after surgery. If by the end of the second week after surgery, the pain syndrome is 0-2 points, this indicates a favorable healing process and the possibility to begin early mobilization of the tendon. During this period, you can gradually increase the weight load on the limb, starting with partial support on the foot. If the pain syndrome persists, it is more than 2 points according to visual analog scale by the end of the second week, which may indicate the development of complications that prevent normal healing: inflammation, failure of sutures, suppuration of the surgical wound. CONCLUSION. The proposed technique using a visual analog scale is a tool for assessing pain and functional status in the preparation of a set of measures for early rehabilitation after surgery for rupture of the Achilles tendon. The assessment of pain symptoms is a determining factor in the introduction of early tendon mobilization. KEYWORDS: Achilles tendon rupture, pain syndrome, early rehabilitation

Preliminary results of acute Achilles tendon rupture treated with platelet-rich plasma and immobilization

Objective: Evaluate preliminary functional results, return to sport, re-rupture rate of acute Achilles rupture treated with one applicationof platelet-rich plasma (PRP), and immobilization.Methods: A prospective analytical study was performed in patients with acute Achilles tendon rupture treated conservatively, associatedwith a single local application of PRP within 10 days of injury. The sample comprised 28 patients diagnosed and monitored by the sameteam for a minimum of 12 months. The American Foot and Ankle Society Functional Rating Scale (AOFAS), Achilles tendon totalrupture score (ATRS), visual analog scale (VAS), and Achilles tendon resting angle (ATRA) were evaluated, the time of return to sportsactivities and isokinetic strength were evaluated at the different follow-up times and injury site using magnetic resonance imaging.Results: The variance analysis of the AOFAS, ATRA, and VAS scores showed a significant difference at six and 12 months regardingthe initial score and according to the injury site. The mean time to return to sports activities was 197 days, 85.7% had homogeneoustendons, and heel-rise type 2 was achieved in 28.6% at six months and 60.7% at 12 months.Conclusion: The protocol proposed by our study for Achilles tendon rupture significantly improved all the scores evaluated comparedto the initial condition and the isokinetic evaluations, obtaining even better results in proximal injuries. Level of Evidence IV; Therapeutic studies investigating the results of treatment; Case series.

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia

ObjectiveThe optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia. MethodsIn a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29–71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29–57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed. ResultsThere was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters. ConclusionEarly dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol. Level of evidenceI, Prospective randomized study

Emerging Patterns of Foot and Ankle Injuries in Pickleball Players: A Short Report.

Pickleball's surging popularity has driven an increase in injuries presenting to medical providers. This study seeks to describe the epidemiology of pickleball foot and ankle injuries including patient demographics, diagnoses, and mechanism of injury. A retrospective review from our institutional database identified patients treated in the foot and ankle clinic whose medical records included the search terms "pickleball" and "pickle ball." Only injuries sustained while playing pickleball were included. Patient demographics, diagnosis, mechanism of injury, and treatment were collected. Injury incidence and descriptive analyses were calculated. A total of 198 patients with pickleball foot and ankle injuries were identified. The incidence of injuries increased 6.5-fold from 2019 to 2023. The mean age of patients was 58.3 years (SD = 12.2). Most patients were male (58.6%) and reported a traumatic injury (77.8%). The most common diagnosis was Achilles tendon rupture (39.4%). The most common mechanisms of injury were running or lunging forward (30.9%), planting the foot (16.5%), and inverting the foot and ankle (15.5%). Most injuries were treated nonoperatively (71.2%); however, 62.8% of Achilles tendon ruptures were treated surgically. The incidence of pickleball foot and ankle injuries increased dramatically from 2015 to 2023. Injuries occurred more frequently in older, male patients, with Achilles tendon rupture being the most common diagnosis.

Derivation and validation of a risk calculator for the prediction of incidence of complications following repair of Achilles Tendon Rupture

BackgroundThe Achilles tendon is the body’s strongest and largest tendon. It is commonly injured, particularly among athletes, accounting for a significant portion of serious tendon injuries. Several factors play a precipitating role in increasing the risk of these injuries.ObjectiveOur objective is to derive and validate a risk calculator for the prediction of incidence of any complication following Achilles tendon repair.MethodsWe used de-identified data from the American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) database from 2005 to 2021. It comprises 7010 individuals who had undergone Achilles tendon rupture repair. Demographic and risk factors information was collected. To develop the calculator, the sample was divided into a derivation cohort (40%) and a validation cohort (60%). Multivariate logistic regression was used for statistical analysis, and a risk calculator for incidence of any complication was derived from the derivation cohort and validated on the remaining 60% of the sample. Patients with missing data were excluded, and the significance level was set at p < 0.05.ResultsWe analyzed the derivation cohort of 2245 individuals who underwent Achilles tendon repair surgery between 2005 and 2021, with a 5.5% overall complication. Multivariate logistic regression identified anesthesia type, ASA classification, certain co-morbidities (pre-operative dialysis and medication-requiring hypertension), and wound classification as significant predictors of complications. The developed risk calculator model had an area under the curve (AUC) of 0.685 in the derivation cohort and 0.655 in the validation cohort, surpassing the widely used and validated modified frailty index. A cut-off score threshold of 0.06 was established using Youden’s index to dichotomize individuals into low and high risk for developing any postoperative complications.ConclusionOur risk calculator includes factors that most significantly affect the incidence of any complication following Achilles tendon repair.

Comparison of different immobilisation durations following open surgery for acute achilles tendon rupture: a prospective cohort study

BackgroundIn recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair.MethodsThis study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected.ResultsThe recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences.ConclusionsImmobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications.Trial registrationClinicalTrials.gov (NCT04663542).

Evaluation of Surgical Reconstruction of Old Tendo Achilles Injury by Bosworth Technique

Background: Chronic Achilles tendon rupture in the watershed hypovascular region (zone II) makes end-to-end repair less feasible. Bosworth's technique, involving gastrocnemius-soleus turndown, was studied to determine its efficacy and functional outcome in repairing chronic tendon in zone II. Objective: To evaluate surgical reconstruction of old Tendo Achilles injury by Bosworth technique. Methods: This prospective study was carried out in Dhaka Medical College Hospital (DMCH) form July 2006 to December 2007. 20 cases were selected as non-randomized purposive sampling technique who came to the out patients department of DMCH. All cases were diagnosed as old neglected Tendo Achilles injury and treated by surgical reconstruction by Bosworth technique. Two cases were lost from follow up and discarded from the study. Finally the study was done on 18 patients. Results: The mean age of the patients was 31.7 years and the lowest and highest cases were 17 and 47 years respectively. The male female ratio was 5:1. One-third (33.3%) patients were day labourer, 22.2% service holders, 16.7% house wives and the rest 27.8% students. Two-Third of the patients (67%) had involvement of left Tendo Achilles and the rest (33%) had right Tendo Achilles. Nearly 40% of patients’ injury was caused by the overhanging edge of the toilet Pan, 27.8% by traumatic rupture, 11.1% assaulted by sharp weapon, another 11.1% by sharp edge of a metallic plate, 5.6% accidentally by sharp cutting knife and 5.5% by broken glass. The mediun level of injury was 3.5 cm above from the insertion of Tendo Achilles, while the lowest and highest level were 2.5 and 6 cm. Minimum delay from injury to operation was 6 weeks and maximum 32 weeks. 5 patients (27.8%) gained normal range of ankle movement, 6 patients (33.3%) decreased by 5° of unaffected side, 4 (22.2%) by 10° and 3 (16.7%) by more than 10⁰. Mean power of planter flexion, mean calf width and mean score to stand on tip toe on injured side relative ........

Paratenon preserving repair of the midsubstance acute Achilles tendon rupture: a systematic review and meta-analysis with best- and worst-case analyses for rerupture rates.

Paratenon preserving techniques to facilitate acute Achilles tendon rupture repair (AATR) functions by maintaining vascularity and biology for optimal healing response. Therefore, the purpose is to evaluate the outcomes following paratenon preserving repair of the midsubstance AATR. The hypothesis was that paratenon-preserving techniques demonstrate high return to play rates and low complication rates for the repair of the midsubstance AATR. A systematic review of the PubMed, Embase, and the Cochrane Library databases was performed by two authors using specific search terms and eligibility criteria. The assessment of the evidence was two-fold: level and quality of evidence. A meta-analysis of proportions for the various complication rates was performed using the restricted maximum likelihood method following the Freeman-Tukey double-arcsine transformation. Fixed effects models were employed if I2 < 25% (low heterogeneity), and random effects models were employed if I2 ≥ 25% (moderate to high heterogeneity). The pooled return to play rate was 90.3%. The pooled rerupture rate as reported was 0.9% (best-case scenario 0.8% and worst-case scenario 6.8%). No meaningful subgroup analysis for rerupture rates could be performed based on the meta-regression. The pooled complication rate other than reruptures was 4.8%. The pooled infection rates were 0.3%, DVT rates were 1.6%, and sural nerve injury rates were 0.3%. Paratenon preserving techniques that are minimally invasive in nature demonstrated safe and favorable outcomes with high return to play rates and low complication rates for the repair of the midsubstance AATR.

Analysis of the effect of all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture

Objective: To examine the feasibility and clinical effect of all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture. Methods: This is a retrospective case series study. From February 2021 to February 2023, the clinical data of 24 patients (30 feet) with Achilles tendon contracture treated with all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening were analyzed retrospectively. There were 10 males and 14 females, aged (32.8±16.1) years (range: 9 to 62 years). There were 8 cases of left side only, 10 cases of right side only and 6 cases of bilateral. There were 14 cases (16 feet) of foot varus, 4 cases (6 feet) of foot valgus, and 6 cases (8 feet) without deformity. All patients underwent all-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening. The surgical effects were evaluated using the maximum dorsal extension angle of ankle joint in knee extension position, the visual analogue scale (VAS) of pain, the American Orthopedic Foot and Ankle Society ankle-hindfoot score(AOFAS-AH). Paired sample t test was used to compare the scores before and after operation. Results: All patients successfully completed the operation, and the operation time of Achilles tendon lengthening was (22.0±5.7)minutes (range: 15 to 35 minutes) and the intraoperative blood loss was (6.5±2.7)ml (range: 2 to 15 ml). All patients primarily healing without any complications such as sural nerve injury, Achilles tendon rupture, important blood vessel injury, and obvious decrease of lift heel strength of achilles tendon. All 24 patients were followed up for (17.2±4.5) months (range: 12 to 28 months). One patient suffered from lift heel's weakness in one foot after operation, and recovered after repeated lift heel functional exercises. The ankle dorsiflexion function of two patients with calf triceps spasm were not improved after operation, and it was obviously improved after botulinum toxin injection. At the last follow-up, the maximum dorsal extension angle of ankle joint in knee extension position increased from -9.2°±7.6°(range:-25° to 5°) preoperatively to 14.5°±7.0°(range:0° to 28°)(t=24.83, P<0.01); the VAS score was reduced from (4.5±1.7) points (range:1 to 8 points) preoperatively to (1.5±0.9) points (range:0 to 3 points) (t=9.53, P<0.01), the AOFAS-AH was increased from (60.5±11.4)points (range:38 to 85 points) to (90.8±5.4) points (range:80-100 points)(t=14.21, P<0.01). Conclusions: All-inside endoscopic procedure through two portals combined with double-hemisection Achilles tendon lengthening for Achilles tendon contracture not only provides Achilles tendon lengthening, but also avoids complications such as Achilles tendon rupture and sural nerve injury. It is an effective method for the treatment of Achilles tendon contracture.

Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation

Achilles tendon reconstruction is an effective method of repairing Achilles tendon rupture defects. We introduce a new approach for Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft. The study aimed to evaluate the clinical role of this new Achilles tendon reconstruction. We retrospectively enrolled patients who underwent Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft for acute Achilles tendon rupture defects from 2016 to 2021. The clinical and radiological results were assessed at the preoperative and the final postoperative follow-up with Visual Analog Score (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores and Achilles tendon Total Rupture Scores (ATRS). Besides, at the last postoperative follow-up, the difference in ankle range of motion between the two side of the patients and the incidence of postoperative complications were recorded. Results revealed patients had significantly lower VAS and higher AOFAS and ATRS (P < 0.01). Compared to the healthy ankle, the operative ankle showed significant deficits in ankle range of motion (P < 0.01). Additionally, radiological results showed no noticeable signs of tunnel enlargement in the calcaneus and no patient had re-rupture. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft is an effective treatment option for patients with acute Achilles tendon rupture with large defects and have high postoperative exercise demands.

Acute rupture of the Achilles tendon : Diagnostics, treatment and aftercare

With up to 50incidents per 100,000 inhabitants, Achilles tendon ruptures are among the most frequent tendon injuries encountered in orthopedics and trauma surgery. Apart from high-risk forms of sport, degenerative processes are primarily responsible for weakening and ultimately rupture. In addition to assessing the typical clinical signs with inability to perform powerful plantar flexion, the diagnostics include easy to earn examination techniques, such as the Thompson test and ultrasound as the imaging gold standard. Conservative and surgical treatment are available depending on the constitution, age and requirements of the patient. The latter option is divided into conventional open, minimally invasive or percutaneous procedures. Good to very good results can be expected regardless of the form of treatment, provided that early functional rehabilitation is carried out. The average rerupture rate is 5% and the return to sport rate is around 80%.

Single-Row Repair Versus Double-Row Repair in the Surgical Management of Achilles Insertional Tendinopathy: A Systematic Review.

Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair. To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes. Systematic review; Level of evidence, 3. A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies-of Interventions and risk-of-bias tool for randomized trials tools. A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P = .01) and mean peak load (433.9 N vs 212 N; P = .042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs. Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes.