Achilles Tendon Research Articles

THE FORTH VALLEY ACHILLES MANAGEMENT PROTOCOL FOR ACUTE ACHILLES TENDON RUPTURES: A PROSPECTIVE OBSERVATIONAL STUDY

This prospective study explores the outcomes of the Forth Valley Protocol (FVP) for the management of acute Achilles tendon ruptures. The protocol uses ultrasound as the primary mechanism to guide treatment.All patients presenting with acute tendoachilles rupture over a three-year period were included. Patients under 18 years of age, chronic ruptures, or prior surgery to the Achilles tendon were excluded. Patients with a gap ≤2cm had conservative management following an Early Rehabilitation Protocol (ERP) and >2cm underwent surgery (if an appropriate surgical candidate). Achilles Tendon Rupture Scores (ATRS) were obtained retrospectively. Fischer's exact test was used to determine statistical significance.158 patients were included with a mean age of 53 (range 20–89). Ultrasound scans were obtained for 121 patients (76.5%), demonstrating a mean tendon gap of 1.61cm. 143 patients managed conservatively and 15 surgically. The overall re-rupture rate was 3.8% (n=6). All the re-ruptures occurred in patients treated conservatively, but this was not found to be statistically significant (n=6, P=1.0). The overall complication rate (excluding re-ruptures) was 1.9%. ATRS was comparable between both treatment modalities (P=0.382, 0.422), with a mean score of 86.6 in the conservative group and 81.4 in the surgical group.The FVP demonstrates low re-rupture and complication rates in line with other published studies. Patients with gaps ≤2.0cm on the ultrasound can be successfully treated conservatively with an ERP. This has potential benefits in terms improved patient outcomes, satisfaction, and preservation of resources.

A comparative study of changes in Hmax/Mmax under spinning permanent magnet stimulation, repetitive peripheral magnetic stimulation, and transcutaneous electrical nerve stimulation in healthy individuals.

We have developed a compact device using a spinning permanent magnet (SPM) that induces an electrical field by changing the magnetic flux. We hypothesized that SPM stimulation also reduced spasticity, comparable with repetitive peripheral magnetic stimulation (rPMS) and transcutaneous electrical nerve stimulation (TENS). This study evaluated the effect of a single session of SPM stimulation and compared it with those of rPMS and TENS in healthy individuals. Eleven healthy adult men participated in this study. The active electrode was placed on the soleus muscle, and the reference electrode was placed at 5 cm distal from the active electrode on the medial side of the Achilles tendon. The stimulating electrodes were fixed on the popliteal fossa to stimulate the tibial nerve. The maximum H-reflex (Hmax) and the maximum motor response (Mmax) were measured, and Hmax/Mmax was calculated under the following conditions: a) 15 min SPM stimulation, b) 30 min SPM stimulation, c) 10,000 pulses rPMS, d) 15 min TENS, and e) 15 min rest (control). The devices for SPM, rPMS, and TENS were applied to the belly of the soleus muscle in the prone position. Compared with the control, Hmax/Mmax significantly decreased under SPM stimulation for 15 and 30 min, as well as under rPMS and TENS (p < 0.005). The changes in Hmax/Mmax under 15 min SPM stimulation were significantly smaller than those under 30 min SPM stimulation and rPMS (p < 0.005). SPM stimulation reduced Hmax/Mmax in healthy individuals and is a potential new treatment for spasticity.

The Correlation between the Elastic Modulus of the Achilles Tendon Enthesis and Bone Microstructure in the Calcaneal Crescent.

The calcaneal enthesis, an osseous footprint where the Achilles tendon seamlessly integrates with the bone, represents a complex interface crucial for effective force transmission. Bone adapts to mechanical stress and remodels based on the applied internal and external forces. This study explores the relationship between the elasticity of the Achilles tendon enthesis and the bone microstructure in the calcaneal crescent. In total, 19 calcaneal-enthesis sections, harvested from 10 fresh-frozen human cadaveric foot-ankle specimens (73.8 ± 6.0 years old, seven female), were used in this study. Indentation tests were performed at the enthesis region, and Hayes' elastic modulus was calculated for each specimen. Micro-CT scanning was performed at 50-micron voxel size to assess trabecular bone microstructure within six regions of interest (ROIs) and the cortical bone thickness along the calcaneal crescent. Significant Spearman correlations were observed between the enthesis elastic modulus and trabecular bone thickness in the distal entheseal (ROI 3) and proximal plantar (ROI 4) regions (R = 0.786 and 0.518, respectively). This study highlights the potential impacts of Achilles tendon enthesis on calcaneal bone microstructure, which was pronounced in the distal calcaneal enthesis, suggesting regional differences in load transfer mechanism that require further investigation.

Pickleball and the Rising Incidence of Achilles Tendon Injuries in the Elderly.

With its rising popularity of pickleball, particularly in the aging population, comes concern for potential injuries that previously rarely affected this patient cohort. The purpose of this study was to investigate the trends of pickleball-related Achilles tendon injuries. A retrospective case series was performed to determine the trends associated with pickleball-related Achilles tendon injuries over the last 10 years. A database search of all Achilles tendon ruptures (ICD-10 S86.0) presenting to a large, multistate, subspecialty referral orthopaedic clinic between January 2013 and June 2023 were identified and included in the study. Pickleball-related injuries were identified via query and confirmed with manual chart review. The incidence of pickleball-related injuries, as well as patient demographics and rate of surgery was determined and compared with the total population during that time period. A total of 2684 patients who suffered an Achilles tendon injury between January 2013 and June 2023 were identified, with 43 patients meeting the inclusion criteria for pickleball-related Achilles tendon ruptures. The number and overall incidence of pickleball-related Achilles tendon injuries has been increasing since 2016, excluding 2020 where there was a large decrease likely due to the COVID-19 epidemic. Pickleball was associated with older age at time of injury (64.5 vs 48.6, P < .001) as well as a lower BMI (26.6 vs 29.4, P < .001). In addition, patients who sustained a pickleball-related Achilles tendon injury were more likely to undergo surgery (67.4% vs 45.4%, P = .008). The rising popularity of pickleball and its associated injuries poses a significant risk to the aging population, with Achilles tendon injuries occurring in older individuals and resulting in a higher likelihood of undergoing surgery. IV; retrospective case-series.

Deprivation of loading during rat Achilles tendon healing affects extracellular matrix composition and structure, and reduces cell density and alignment.

Tendon healing involves mechanosensitive cells that adapt to mechanical stimuli through mechanotransduction, resulting in increased tissue strength. However, detailed insights into this process in response to different loads remain limited. We aimed to investigate how different loading regimes impact the spatial composition of elastin and collagens during Achilles tendon healing. Histological analysis was conducted on healing rat Achilles tendons exposed to (1) full loading, (2) reduced loading, or (3) minimal loading. Histological analysis included Hematoxylin & Eosin and immunohistochemical staining targeting elastin, Collagen1, Collagen3, and CD31. Our results showed that the impact of mechanical stimuli on healing tendons varied with the degree of loading. Unexpectedly, minimal loading led to higher staining intensity for collagens and elastin. However, tendons exposed to minimal loading appeared thinner and exhibited a less organized matrix structure, with fewer, less aligned, and more rounded cells. Additionally, our findings indicated an inverse correlation between angiogenesis and load level, with more blood vessels in tendons subjected to less loading. Tissue integrity improved by 12 weeks post-injury, but the healing process continued and did not regain the structure seen in intact tendons even after 20 weeks. This study reveals a load-dependent effect on matrix alignment, cell density, and cell alignment.

Acute Achilles Tendon Ruptures: An Update on Current Management Strategies

Acute rupture of the Achilles tendon is a frequently encountered injury that occurs most commonly in people who participate in recreational athletics into their thirties and forties. For many years, the injury has been treated either nonsurgically or surgically using a standard open approach. More recently, a variety of new surgical techniques have emerged in the literature aiming to improve surgical outcomes while decreasing the potential complications associated with standard open repair. Nonsurgical treatment plans using early weight bearing and accelerated functional rehabilitation have also proven to be excellent management options. Achilles rupture treatment plans can include the use of orthobiologics, such as platelet-rich plasma, with mixed results. Accelerated functional rehabilitation protocols have shown to improve patient outcomes, whether used in conjunction with surgery or nonsurgical management modalities, and reduce the disparity between the injured tendon and the native Achilles.

THE INFLUENCE OF THE CULTURE OF FIBROBLASTIC CELL ELEMENTS ON THE INDICATORS OF THE METABOLISM OF CONNECTIVE TISSUE IN EXPERIMENTAL ANIMALS

The number of patients with degenerative tendon disease affects millions of people both among athletes and the general population, causing significant socio-economic consequences. Despite the availability of various methods of conservative and surgical treatment, more than a third of patients experience constant pain. Objective. To study the indicators of the metabolism of connective tissue in animals with a model of degenerative damage to tendons against the background of the introduction of a culture of fibroblastic cell elements. Methods. Therefore, the development of methods for restoring the structure of tendons using cell cultures, in particular fibroblasts, will allow to optimize the course of reparative processes, reduce the risk of complications during surgical intervention and accelerate healing, and at the molecular level — to improve the structure of collagen fibers. Laboratory studies of biochemical markers of a tendon with a degenerative-dystrophic lesion and against the background of the introduction of cell culture can help in the differential diagnosis of its extracellular matrix. Results. The experimental data obtained by us indicate the presence of differences in the biochemical markers of tendons with degenerative-dystrophic lesions in rats 7, 21, and 45 days after the introduction of culture of fibroblastic cell elements. However, 45 days after the introduction of the culture of fibroblast cell elements, the normalization of metabolic processes in the extracellular matrix of connective tissue occurs, namely, the activity of collagenase and the concentration of protein-bound hydroxyproline approaches normal values. This indicates the predominance of the synthetic phase over the catabolic one in collagen metabolism. Conclusions. In this context, the introduction of culture of fibroblastic cell elements, as an alternative anti-inflammatory method, may provide another potential opportunity in the treatment of chronic degenerative-dystrophic lesions of the Achilles tendon.

Regional changes in the free Achilles tendon volume in response to repeated submaximal contractions

IntroductionThe Achilles tendon (AT) may become smaller in volume following acute bouts of heavy and sustained loading likely because of transient fluid exudation to the periphery and this could augment cellular mechanotransduction and tendon adaptation. Given the structure of the AT is distinct across its length, regional changes in the free AT volume may occur in response to loading. This study aimed to investigate whether the change in tendon volume in response to repeated submaximal loading is distinct across the free AT length. MethodsSixteen ATs of healthy males and females (age 24.4 ± 9.4 years, body mass 70.9 ± 16.1 kg, height 1.7 ± 0.1 m) were scanned at rest using freehand 3D ultrasound. Scanning was done before and immediately after submaximal (75 %) voluntary isometric plantarflexion contractions (8 s) involving four sets of ten repetitions. Regional volumetric changes were assessed across the free AT length by dividing the tendon into distal, mid, and proximal regions. ResultsSignificant reduction in the free AT volume occurred across all tendon regions in response to the intervention, however, the mid- region exhibited the greatest reduction in volume compared to the proximal region (P = 0.025). DiscussionThe fact that volume reduction was greatest in the mid-region compared to the proximal region of the free AT may suggest greater tendon adaptation, via mechanotransduction pathways, in the mid-region and this may be important for tendon health and injury prevention.

Double Row Hip Abductor Reconstruction with Fasciae Latae Transfer for Severe Trendelenburg after Hip Arthroplasty

Background/Objectives: Tendinopathy of the gluteus medius and minimus tendons is a primary source of lateral hip pain, ranging from interstitial and partial-thickness tears to complete tears. Treatments include muscle transfers, Achilles tendon allograft procedures, and primary repairs with allografts. This study evaluated the one-year outcomes of gluteus medius and minimus reconstruction using an open double-row technique with a partial tensor fasciae latae transfer for severe Trendelenburg post-total hip arthroplasty. Methods: A prospective study involving eight patients who underwent surgery from April to December 2023 was conducted. The surgery involved an open technique with double-row suture reinforcement and tensor fasciae latae autograft. Outcomes were measured using strength, the Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF-12), Hip Outcome Tool (HOT), International Hip Outcome Tool (iHOT), and Visual Analog Scale (VAS). Follow-ups occurred at 1, 3, 6, 9, and 12 months postoperatively. Results: At an average follow-up of 7.17 months, significant improvements in both hip function and quality of life were observed. The SF-12 quality of life score increased from 27 preoperatively to 34 by month 12. Hip functionality, as measured by the HHS, showed a marked improvement from 48 to 94 points, particularly after six months. The HOT score for hip functionality rose by 23 points by the third month, reaching an average of 86 points. Similarly, the iHOT score increased from 20 to 83 points starting at month 3, reflecting substantial improvements in hip function. Statistically significant improvements were noted at as early as month 3 (p = 0.02), with highly significant gains by month 6 (p &lt; 0.01), which remained stable through month 12 (p &lt; 0.01). Conclusions: Reconstruction of the gluteus medius and minimus tendons using an open double-row technique with a partial tensor fasciae latae transfer significantly enhances hip function and quality of life. Over an average follow-up period of 7.17 months, patients experienced notable improvements. This technique is an effective option for treating lateral hip pain due to tendinopathy.

Validation of Fixed Ultrasonography for Achilles Tendon Assessment: A Reliability Study

Background: It is important to highlight the advantages of ultrasound in assessing muscular and tendinous behavior due to its non-invasive nature and capacity for dynamic studies. However, evaluating tendons via ultrasound can be challenging given the complexity of anisotropic phenomena related to collagen fiber arrangement. This study aims to validate the reliability of fixed ultrasound compared to manual acquisition in measuring Achilles tendon thickness. Method: Twenty participants, six men and fourteen women, were recruited. Ultrasound was used to measure the Achilles tendon’s thickness at two specific points (4 and 6 cm from the calcaneal insertion of the Achilles tendon). The measurements were conducted by two examiners, one with previous experience and another without. Results: The measurements at 6 cm from the calcaneal insertion showed α = 0.996, α = 0.998 for measurements at 4 cm using manual acquisition, and α = 0.997 for measurements with fixed ultrasound at rest. For the weight-bearing and ankle dorsiflexion measurements, the reliability was excellent (α = 0.999 and α = 1.000). Conclusions: The findings demonstrated excellent reliability in the ultrasound measurements of the Achilles tendon’s thickness, even when performed by different evaluators and under load-bearing conditions. This study suggests the clinical utility of assessing anatomical structures under load, enhancing ultrasound’s applicability beyond the examination table. It is concluded that fixed ultrasound acquisition exhibits excellent reliability in measuring the Achilles tendon’s thickness, offering potential benefits for precise diagnosis of pathologies, planning surgical interventions, and reducing possible errors related to operator variability.

Collagen denaturation in post-run Achilles tendons and Achilles tendinopathy: In vivo mechanophysiology and magnetic resonance imaging.

Achilles tendinopathy is often attributed to overuse, but its pathophysiology remains poorly understood. Disruption to the molecular structure of collagen is fundamental for the onset and progression of tendinopathy but has mostly been investigated in vitro. Here, we interrogated the in vivo molecular structure changes of collagen in rat Achilles tendons following treadmill running. Unexpectedly, the tendons' collagen molecules were not mechanically unfolded by running but denatured through proteolysis during physiological post-run remodeling. We further revealed that running induces inflammatory gene expressions in Achilles tendons and that long-term running causes prolonged, elevated collagen degradation, leading to the accumulation of denatured collagen and tendinopathy development. For applications, we demonstrated magnetic resonance imaging of collagenase-induced Achilles tendon injury in vivo using a denatured collagen targeting contrast agent. Our findings may help close the knowledge gaps in the mechanobiology and pathogenesis of Achilles tendinopathy and initiate new strategies for its imaging-based diagnosis.

Pain Provocation With Progressive Loading Is the Most Common Diagnostic Method for Achilles Tendinopathy: An International Cross-Sectional Study of 1048 Physiotherapists

OBJECTIVE: To explore and define the diagnostic criteria and practices employed by physiotherapists worldwide for Achilles tendinopathy. DESIGN: A cross-sectional study using an anonymous online survey distributed to physiotherapists internationally. The survey captured diagnostic criteria, use of objective tests, and imaging techniques in the management of Achilles tendinopathy. METHODS: The survey, collaboratively designed by experts in Achilles tendinopathy, comprised 27 questions covering demographic information, diagnostic practices, and the use of imaging. The survey was disseminated through various social media platforms and professional events. All data were collected via REDCap. RESULTS: One thousand and forty-eight physiotherapists completed the survey. Physiotherapists reported that symptom response to a series of progressive Achilles loadings tests (92%), pain tolerance palpating the Achilles tendon (79.8%) and visual comparison of the Achilles tendon (63.8%) were helpful objective tests to establish a diagnosis of Achilles tendinopathy. The most commonly referred form of imaging was ultrasound at radiology clinics (n =460, 63.3%). CONCLUSION: This global survey provides clinical perspective of physiotherapists diagnosing Achilles tendinopathy Although using a progressive loading protocol to form a clinical diagnosis, physiotherapists were also using pain elicited on palpation 79.8% to further establish diagnosis of Achilles tendinopathy, despite recent studies that have demonstrated Achilles palpation pain is present in a variety of posterior ankle conditions and that there is no standardised pressure for palpation.

Anatomy of the Achilles tendon-Apictorial review.

The Achilles tendon (AT) is the strongest tendon of the human body. The knowledge of AT anatomy is abasic prerequisite for the successful treatment of acute and chronic lesions. The structure of the AT results from acomplicated fusion of three parts: the tendons of the medial and lateral gastrocnemius and the soleus muscles. From proximal to distal, the tendon fibers twist in along spiral into aroughly 90° internal rotation. The tendon is narrowest approximately 5-7 cm above its calcaneal insertion and from there it expands again. The topography of the footprints of the individual AT components reflects the tendon origins. The anterior (deep) AT fibers insert into the middle third of the posterior aspect of the calcaneal tuberosity, the posterior (superficial) fibers pass over the calcaneal tuberosity and fuse with the plantar aponeurosis. Adeep calcaneal bursa is interposed between the calcaneal tuberosity and the AT anterior surface. The AT has no synovial sheath but is covered along its entire length with asliding connective tissue, the paratenon which is, however, absent on its anterior surface. The AT is supplied by the posterior tibial artery (PTA) and the peroneal artery (PA). Motor innervation of the triceps surae muscle is provided by fibers of the tibial nerve which also gives off sensitive fibers for the AT. Sensitive innervation is also provided via the sural nerve. The sural nerve crosses the AT approximately 11 cm proximal to the calcaneal tuberosity. The forces acting on the AT during exercise may be up to 12 times the body weight. Physiological stretching of AT collagen fibers ranges between 2% and 4% of its length. Stretching of the tendon over 4% results in microscopic failure and stretching beyond 8% in macroscopic failure.

Achilles tendinopathy treatment via circadian rhythm regulation

IntroductionAchilles tendinopathy (AT) is a prevalent musculoskeletal disorder closely linked to oxidative stress. Existing evidence suggests a potential link between circadian clock rhythms and oxidative stress. However, the precise role of the circadian clock in the progression and treatment of AT remains unclear. ObjectiveThe purpose of this study was to investigate the role of the Achilles tendon circadian clock in AT pathology and explore the potential use of biomaterials for modulating the circadian clock in the treatment of AT. MethodsWe utilized in vivo and in vitro models to investigate the alterations of the circadian clock within the Achilles tendon during the progression of AT, as well as its impact on disease development. Additionally, we fabricated Nb2C@CeO2 composites featuring a Schottky heterojunction for regulating the circadian rhythm and validated its therapeutic efficacy and molecular mechanism of AT through both in vivo and in vitro experiments. ResultsThe Achilles tendon functioned as a peripheral oscillator with an independent and self-sustained time-keeping system. The rhythm of the Achilles tendon clock was disrupted during the development of AT, as indicated by the decreased amplitude of Bmal1 and Nrf2 rhythm expression. Mechanistically, the knockdown of Bmal1 disrupted the Achilles tendon clock, thereby destroying the Bmal1-Nrf2 axis dependent molecular defense mechanism, and exacerbating the inflammatory response, whereas overexpression of Bmal1 had a protective effect. Nb2C@CeO2 composites with Schottky heterojunctions enhance intercellular electrical signaling, boosting Bmal1 expression and mitigating AT’s pathological changes. Importantly, enhancing Bmal1 expression during its peak, rather than its trough, was more effective. ConclusionThis study identified the protective role of the circadian clock against oxidative stress and inflammation in the Achilles tendon. Achilles tendon circadian clock-targeted therapy represents a promising strategy for AT treatment.

Post-mechanotherapy differences in postural control in patients with Achilles tendinopathy - a randomized controlled trial

BackgroundNeuromuscular deficits affecting functional ability can occur in patients with Achilles tendinopathy during difficult balance activities. This study aimed to assess postural control in patients with Achilles tendinopathy after shockwave and sonotherapy, using advanced analytical methods, including rambling-trembling signal decomposition and sample entropy. Research questionWhat are the differences in postural control between patients with Achilles tendinopathy after shockwave therapy, ultrasound therapy, and placebo ultrasound? MethodsThirty-nine patients were included in the study, and randomly assigned to 3 groups, i.e., shockwave therapy, ultrasound therapy and placebo ultrasound. Postural sway was assessed during quiet standing with eyes open and closed, with two force platforms, one for the affected and the other for the non-affected limb, at baseline and at weeks 1 and 6 after treatment. Rambling-trembling trajectories and sample entropy were calculated for the antero-posterior and medio-lateral directions. ResultsThe parameters of trembling trajectory in both directions were significantly smaller for the affected compared to non-affected limb. The ultrasound group had significantly larger rambling-trembling trajectories in the antero-posterior and medio-lateral sway directions than the shockwave therapy group. Also, all patients had more difficulty controlling their postural sway while standing with eyes closed compared to eyes open. Sample entropy was not significantly affected by the therapy type, timepoint and limb condition. SignificanceAs opposed to sample entropy, rambling-trembling decomposition can complement or replace traditional linear measures of COP time series in functional assessment of the Achilles tendon.

Haglund’s Deformity, Retrocalcaneal Bursitis, and Achilles Tendinopathy (Haglund’s Syndrome) Treated with Arthroscopic Calcaneoplasty, Synovectomy and PRP Injection Outcome Score: A Case Report

Haglund’s Deformity, Retrocalcaneal Bursitis, and Achilles Tendinopathy (Haglund’s Syndrome) Treated with Arthroscopic Calcaneoplasty, Synovectomy and PRP Injection Outcome Score: A Case Report

Ankle proprioception and functional performance in patients with Achilles Tendinopathy

Ankle proprioception and functional performance in patients with Achilles Tendinopathy

Achilles Tendon Strain In Runners With Achilles Tendinopathy During Running

Achilles Tendon Strain In Runners With Achilles Tendinopathy During Running

Barefoot vs shod walking and jogging on the electromyographic activity of the medial and lateral gastrocnemius

Gastrocnemius weakness is associated with Achilles tendinopathies and muscle strains, with the medial gastrocnemius (MG) more commonly injured than the lateral gastrocnemius (LG). Walking and jogging are common in daily activities and sports, and biomechanical differences between shod and barefoot exercise may influence MG and LG activation. Understanding these activation patterns could help optimize training programs for injury prevention and/or rehabilitation. The aim was to compare MG and LG electromyographic activity during walking and jogging, both shod and barefoot. Twenty-nine participants (25.28 ± 4.53 years, 171.31 ± 0.76 cm, 72.68 ± 6.36 kg) completed a warm-up followed by 1 min of walking (80–99 steps/min) and jogging (130–150 steps/min) in both conditions (barefoot and shod, random order). Electromyographic signals were recorded using wearable devices (mDurance Solutions S.L., Granada, Spain; 1024 Hz sampling rate). We measured the root-mean-square (RMS) amplitudes for an entire stride cycle and digitally filtered the signals. For analysis, we normalized electromyographic values to the average peak values obtained during two sprints. We analyzed differences with a repeated-measures analysis of variance. Significant effects of condition (barefoot-shod) and gastrocnemius (MG-LG) were observed (all p ≤ 0.023, ƞp2 = 0.17–0.39), with higher MG activation compared to LG in the barefoot conditions (p = 0.004–0.027, d = 0.72–0.83), and nonsignificant differences between muscles in the shod conditions (p > 0.05). Shod exercise compared to barefoot resulted in lower MG activation (p = 0.001–0.003, d = 0.62–0.63) and non-significant differences in LG activation. These results indicate that barefoot walking and jogging increase MG activation compared to shod conditions, with no differences in LG activation. Additionally, footwear reduces differences between MG and LG.

Surgical Treatment of Insertional Achilles Tendinopathy Augmented With Human Acellular Dermal Matrix: A Retrospective Case Series

Background: Insertional Achilles tendinopathy (IAT) is often surgically treated with Achilles tendon partial or total detachment, debridement and repair of the Achilles tendon, excision of retrocalcaneal exostosis, and suture anchor reattachment. To date, there is no report that examines the use of acellular dermal matrix (ADM) augmentation in this procedure without the use of suture anchor reattachment. Methods: Thirty-two female and 10 male patients (mean age 52 years) with IAT underwent surgical treatment including partial detachment of the Achilles tendon, excision of the retrocalcaneal exostosis, debridement and repair of the Achilles tendon, and augmentation with human acellular dermal matrix allograft. Outcomes measured were the visual analog scale (VAS) score, time to weightbearing, major and minor complications. Results: Forty-two patients were followed for a mean of 20.8 months. The VAS score improved from a mean of 5.1 to 1.9 at final follow-up. The mean time to weightbearing was 4.4 weeks. Eleven patients (26.2%) experienced complications. One patient (2.4%) suffered a rupture of the Achilles in the early postoperative period. Three patients (7.1%) had delayed wound healing, with 1 (2.4%) requiring surgical debridement. Two (4.8%) experienced continued pain requiring further surgical treatment. Conclusion: This protocol for surgical treatment of IAT with the use of human ADM allograft augmentation resulted in improved VAS scores and was associated with a low risk of postoperative infection without a prolonged nonweightbearing period. Level of Evidence: Level IV, retrospective case series.