Artistic gymnastics is a complex and challenging sport. The specific demands of gymnastics place athletes at unique risk of injuries to the spine, as well as upper and lower extremities. Changes to the rules and scoring system since the 2004 Olympics have encouraged athletes to perform more challenging skills, adding to the risk of injury. Single-sport specialization occurs at a young age among competitive gymnasts, introducing an increased risk of overuse injuries. Common injuries include spondylolysis, medial-sided elbow injuries, gymnast's wrist, ligamentous injuries of the knee, and Achilles tendon ruptures. It is important to understand these injury patterns to properly prevent, treat, and safely return these athletes to play.

Peroneal tendon pathologies are frequently associated with ankle sprains. However, the incidence and demographics of peroneal tendon pathology remain undetermined. This study aims to present surgeon- and patient-reported data of patients undergoing first-time surgery for peroneal tendon pathology with data extracted from the Swedish Foot and Ankle Register (Swefoot). Data from 719 patients between December 2015 and November 2022 underwent analysis. The data included patient characteristics, surgeon-reported findings and preoperative Self-Reported Foot and Ankle Score (SEFAS) and EuroQol 5-Dimension 3-Levels (EQ-5D-3L) assessments. The mean age at surgery was 49 years. Peroneal tendon rupture is the most frequent diagnosis. A higher prevalence of peroneal tendon pathology, specifically peroneus brevis rupture and tendinosis, was observed in women compared to men. Pre-operatively, patients exhibited moderate functional impairment and diminished health-related quality of life compared with normative values. This is Sweden's first large-scale demographic study of peroneal tendon pathologies. Further research is required to comprehensively elucidate demographic patterns. Observational study, Level 3.

Surface EMG analysis of tibialis anterior and gastrocnemius activity under different loading positions.

Psychological and functional assessment of Achilles tendon ruptures and their return to sports.

Incomplete recovery with persistent muscle weakness is frequently observed following Achilles tendon rupture. The mechanisms for this weakness remain unclear, but tendon elongation has been suggested as a contributing factor. The aim of this study was to compare tendon and muscle morphology in high- and low-functioning patients more than 2 years after non-surgical treatment of a total Achilles tendon rupture. Forty-six patients underwent screening, including a standardized heel-rise work test on both legs. Based on this test, a heel-rise index (HRI) for total muscle work, categorized 29 patients into a low- (HRI < 33%) or high-functioning (HRI > 67%) group. Both groups underwent bilateral magnetic resonance imaging to assess tendon and muscle morphology, and the main variable was tendon elongation. High-functioning patients were on average 13 years younger than the low-functioning patients (p < 0.001). Free tendon length was longer on the injured side in both groups, 3.59 and 5.19 cm in the high- and low-functioning group (p = 0.053). Tendon cross-sectional area was significantly larger in the high-functioning group compared to the low-functioning group (383% vs. 256% after normalization to the uninjured side, p = 0.005). The soleus muscle had notable differences between the groups, as low-functioning patients had a smaller mediolateral diameter (p = 0.002), a more pronounced muscle length difference (p = 0.009) and a higher atrophy grading. Additionally, there were significant correlations between age, HRI and tendon size. Free tendon length after rupture may play a role in muscle weakness. However, tendon elongation does not necessarily lead to low function, as it was also evident in the high-functioning group. These findings may be important, as they suggest that tendon elongation is not the sole determinant of functional outcome and that other factors may contribute to muscle performance after rupture. Further research is needed on the role of age in muscle function following Achilles tendon ruptures. Level III.

Achilles tendon rupture impairs the functional performance of the triceps surae muscle-tendon unit. However, long-term effects of different rehabilitation programs on these impairments remain unclear. This study evaluated the long-term effects of early rehabilitation versus cast immobilization after Achilles tendon repair. We also examined whether the uninjured side could serve as a reference for the "healthy" side. Males with previous Achilles tendon rupture (n=20) and a group of healthy male controls (CTR; n=10) participated. Achilles tendon rupture participants included a short-term physical therapy group (STPT; n=10) and a plaster cast group (PC; n=10). Triceps surae morphology of the injured leg and ankle functionality of both injured groups was compared with that of the uninjured leg and with that of CTR legs. No between-group differences were found in the patient-reported outcomes. The injured side presented lower heel rise height, plantar flexors strength, gastrocnemius medialis thickness, calf volume, and shorter fascicle length than CTR. On the injured side, the STPT preserved ankle range of motion and showed greater plantar flexion and total range of motion than the PC. We employed a computational model that demonstrated that tendon elongation was the main determinant of heel rise height deficit. The uninjured side presented lower heel rise height than the CTR group. Despite favorable patient-reported outcomes, long-term structural and functional deficits persist after Achilles tendon rupture, regardless of rehabilitation approach. Findings suggest that the rehabilitation programs used did not fully restore muscle-tendon function and highlight limitations of using the uninjured side as a control.

Chronic insertional rupture of the tibialis anterior tendon is uncommon and presents substantial reconstructive challenges, particularly when associated with large tendon defects and distal degeneration. Primary repair is often not feasible in such cases, and conventional reconstructive techniques frequently require prolonged postoperative immobilization, delaying functional recovery. We report a case of chronic insertional tibialis anterior tendon rupture in a 64-year-old Japanese male recreational weightlifter, treated with reconstruction using an ipsilateral semitendinosus autograft. A modified side-locking loop suture technique was employed for proximal fixation, and anatomical distal fixation was achieved using multiple all-suture anchors. This construct was designed to provide sufficient initial biomechanical stability to permit early postoperative rehabilitation. Postoperatively, the ankle was immobilized for 2weeks, followed by initiation of active range of motion exercises and progressive weight-bearing. At the 2-year follow-up, the patient demonstrated complete pain relief, normal gait, and excellent functional recovery. Isokinetic testing revealed dorsiflexion strength exceeding 95% of the contralateral side, and magnetic resonance imaging confirmed continuity and favorable remodeling of the reconstructed tendon. This case demonstrates that reconstruction of chronic insertional tibialis anterior tendon rupture using a semitendinosus autograft combined with a modified side-locking loop suture and multi-anchor fixation can provide sufficient stability to allow early functional rehabilitation. This approach may represent a viable treatment option for active patients with large tendon defects.

As scientific publishing has shifted to digital platforms, two primary article-publishing modalities have emerged: open access and closed access. Open access is freely accessible with an article processing charge (APC) paid by authors, whereas closed access lies behind paywalls, with low to no APC for authors. As the academic community increasingly relies on digital dissemination, it is critical to evaluate how these models influence research visibility and impact. This study compared open versus closed access randomized control trials (RCTs) across five prevalent orthopaedic conditions by analyzing attention scores, social media metrics, readership, and citations. The study hypothesis was that open access publications would have higher attention and readership, whereas closed access articles would yield more citations. A PubMed search was conducted in May 2025 to identify RCTs on rotator cuff tears, carpal tunnel syndrome, hip fractures, anterior cruciate ligament tears, and Achilles tendon ruptures. Altmetric Attention Scores, X mentions, Facebook mentions, news mentions, Mendeley readers, and Dimensions citations were collected for each article using the Altmetric Explorer database. A negative binomial regression, adjusted for time since publication, was used to compare metrics between open and closed access publications. Of 1,223 articles studied, 53.8% of the articles were open access and 46.2% were closed access. Open access articles had significantly higher Altmetric Attention Scores (44.1 ± 197 vs 17.2 ± 52.0), X mentions (32.2 ± 27.1 vs 17.4 ± 38.4), Facebook mentions (1.2 ± 4.3 vs 1 ± 2.5), news mentions (4.1 ± 25.2 vs 1.0 ± 7.2), number of Mendeley readers (136.6 ± 127.9 vs 113.4 ± 108), and, notably, number of Dimensions citations (36.8 ± 88.9 vs 30.1 ± 45.6) compared with closed access articles ( P < 0.05). Contrary to our initial hypothesis, open access articles had higher attention metrics and citation numbers when compared with closed access publications. These findings suggest that open access publishing not only enhances visibility and engagement but also may increase academic impact across multiple orthopaedic subspecialties.

When an adult with rotator cuff tendinopathy reports feeling or hearing a pop along with new pain, both the clinician and the patient may inaccurately and unhelpfully expect (framing heuristic) an injury and consider it a compensable work claim. We retrospectively reviewed medical records of 118 people that filed work claims for new shoulder pain where aspects of their care or recovery trajectory triggered a peer review. We collected data on age, sex, reports of hearing or feeling a pop (25%; 29 of 118 patients), and reports of new numbness or tingling (11%; 13 of 118 patients). Five (4%) patients had a possible acute rotator cuff rupture (relatively large defect with good muscle) and 11 (9%) had a long head of biceps rupture, age indeterminate. Accounting for confounding variables using logistic regression, possibly acute rotator cuff defects and age-indeterminate long head of biceps ruptures were associated with older age (odds ratio [OR], 1.10; 95% CI, 1.02-1.18) and the presence of a degenerative rotator cuff defect (OR, 6.0; 95% CI, 1.5-24) but not with sensation of a "pop." Based on this evidence, among people claiming injury at work, when a "pop" is reported the clinician should not expect new pathophysiology. III.

Age Is Not a Contraindication: Outcomes of Distal Biceps Tendon Repair in Elderly Patients.

Background: Although ultrasonography is useful for assessing soft-tissue injuries, its role in classifying tendinous mallet injuries remains underdefined. This study aimed to propose a modified ultrasonographic classification system that combines Wang's classification with additional subtypes emphasising lateral band involvement to improve diagnostic accuracy and prognostic assessment. Methods: A retrospective cross-sectional study was performed on 36 patients with acute closed tendinous mallet injuries of the fingers. All patients underwent ultrasonographic evaluation. Based on the modified classification, Wang Type B was subdivided into Subtype B1 (complete terminal tendon rupture) and Subtype B2 (rupture of either the radial or ulnar slip of the lateral band). Clinical outcomes were recorded at a minimum of 4 months of follow-up. Data on pinch strength, pain, extension lag and functional scores were analysed to compare outcomes across the three injury types. Results: Fifteen Type B1, eight Type B2, and 13 Type C injuries were identified. In all types, as the length of the injured tendon increased, pinch strength relative to the contralateral side was significantly weaker. Additionally, the injured tendon was significantly longer in Type C injuries than in Type B1 and B2 injuries. As the length of the injured tendon increased, pinch strength relative to the contralateral side decreased across all injury types. Nevertheless, the pain score, functional score and initial extension lag did not show statistically significant variations amongst injury types. Crawford criteria showed that Types B2 and C injuries were mostly graded as 'excellent' or 'fair', whereas Type B1 injuries were more often classified as 'poor' or 'fair'. Conclusions: The modified ultrasonographic classification provides a more detailed framework for assessing tendinous mallet injuries by integrating Wang's classification and distinguishing partial lateral band ruptures. This approach enhances diagnostic precision and may improve functional prognostication. Level of Evidence: Level IV (Diagnostic).

To compare the career longevity of professional soccer players after achilles tendon rupture (ATR) with that of an uninjured matched control cohort. A retrospective analysis of ATR cases in professional male athletes from the English Premier League and English Championship was performed. Each athlete with ATR was matched to three control athletes who had not sustained ATR. The analysis included all identified ATR cases, including those who failed to return to professional competition. Statistics were compiled for each year until retirement or study end. A total of 36 players with ATR were matched to 108 controls. The return-to-professional play rate following ATR was 91.7%. The mean career length after ATR was 4.9 ± 3.3 years, while that of the matched control athletes was 3.4 ± 3.5 years (p = 0.045). After ATR, an athlete had a 33% lower risk of retirement compared with the matched control athlete, which approached statistical significance (hazard ratio [HR] = 0.67; 95% confidence interval [CI], 0.45-1.00; p = 0.051). Significant subsequent non-ATR injuries were documented in 24.1% of control athletes during the follow-up period. At 5 years after ATR, 58.3% of athletes had retired from professional soccer, while 70.4% of the matched cohort were retired (p = 0.259). By 10 years, 83.3% of the ATR cohort had retired compared with 91.7% of the matched cohort (p = 0.270). Within the ATR cohort, re-rupture occurred in seven players (19.4%) but did not significantly affect career length (HR = 0.80; p = 0.622). Age at ATR remained the strongest predictor of retirement (HR = 1.27 per year; p < 0.001). Professional male soccer players who sustained ATR demonstrated comparable career longevity to a matched player cohort, with a trend toward longer survival in those who successfully return to play. ATR did not significantly shorten professional careers in this elite population. This likely reflects the efficacy of modern rehabilitation, a potential selection effect, and the high non-ATR injury burden observed in the control group. Level III.

Ultrasound gap distance has been proposed as a supportive triage input within protocol-based pathways after acute Achilles tendon rupture. We assessed intra-/inter-rater reliability of gap measurement and the extent of classification uncertainty around a 5-mm threshold. Retrospective observer-agreement study without a definitive reference standard, using protocol-acquired stored ultrasound cine loops from 30 clinically diagnosed complete acute ruptures in a prospectively collected cohort. Retrospective observer-agreement study without a definitive reference standard, using protocol-acquired stored ultrasound cine loops from 30 clinically diagnosed complete acute ruptures in a prospectively collected cohort. Two blinded musculoskeletal radiologists re-reviewed stored cine loops and measured tendon-gap distance in two sessions each (≥ 4weeks apart). We calculated intraclass correlation coefficients (ICC), Bland-Altman mean difference and 95% limits of agreement (LoA), and standard error of measurement (SEM). Agreement at the 5-mm protocol cut-point was assessed using Cohen's κ and Gwet's AC1. Using SEM, we derived 90% confidence zones indicating firm classification versus a grey zone where repeat measurement or second read may be considered. Intra-rater ICC(2,1) was 0.88 (95% CI 0.83-0.91) and 0.94 (0.82-0.97); SEMs were 1.57 and 1.19mm. Inter-rater bias was + 1.12mm with LoA - 3.85 to 6.10mm. Agreement for study experimental pathway classification at the 5-mm cut-point (operative vs non-operative) was moderate (κ = 0.60; AC1 = 0.61), with 6/30 examinations classified differently. SEM-based 90% zones were ≤ 2.42 and ≥ 7.58mm (rater 1) and ≤ 3.04 and ≥ 6.96mm (rater 2); a conservative cross-rater rule suggested ≤ 2.05 or ≥ 7.95mm. Gap measurement shows good relative reliability, but uncertainty near 5mm can alter classification. Reporting LoA/SEM alongside ICC and flagging a grey zone may reduce misclassification in borderline cases.

Isolated Endoscopic Flexor Hallucis Longus Transfer Versus Open Primary Repair for Acute Achilles Tendon Ruptures: A Retrospective Comparative Study.

To evaluate whether individualised treatment using the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) is superior to default operative or non-operative strategies. We conducted a multicentre, three-arm, randomised controlled trial. Adults with acute Achilles tendon rupture were randomised (1:1:1) to individualised CARTA, non-operative or operative treatment. In the CARTA arm, surgery was indicated if ultrasound showed<25% tendon overlap or ≥7% elongation. The primary outcome was the Heel-Rise Work Test (HRWT) at 12 months. Secondary outcomes included HRWT at 6 months, and at both 6 and 12 months, the Heel-Rise Height, Achilles tendon Total Rupture Score (ATRS), Tegner activity scale, Copenhagen Achilles tendon Length Measure, Achilles Tendon Resting Angle (ATRA) and complication recordings. Between May 2018 and June 2023, 970 patients were screened; 300 were randomised (male/female 76%/24%, mean age 41 (SD 1)). At 12 months, data were available for 98 CARTA (64% operated), 100 non-operative and 97 operative patients. There were no significant between-group differences in HRWT at 12 months. However, CARTA significantly reduced rerupture rates by 73% compared with non-operative treatment (3% (95% CI) (1 to 8) vs 11% (6 to 19), p=0.03), improved ATRS by 8 points (1 to 15, p=0.02) and improved ATRA by -2° (-4 to -1), p=0.01). No difference between CARTA and operative treatment was found except 36% less underwent surgery. Individualised CARTA did not improve functional outcomes based on the HRWT at 12 months, but among secondary outcomes, it reduced rerupture rates and improved patient-reported outcomes compared with non-operative treatment and with fewer surgeries than routine operative care. NCT03525964.

Achilles Tendon Injury Alters Lymphatic and Venous Clearance in Rats.

To report the outcomes of cats treated for Achilles tendon (AT) rupture with a recently commercialized synthetic ultra-high-molecular-weight polyethylene (UHMWPE) implant and no transarticular fixation. Retrospective multicenter study. A total of 11 cats (13 limbs). Medical records from seven veterinary centers were reviewed for cats undergoing AT repair with the Novaten implant between 2021 and 2024. Feline musculoskeletal pain index (FMPI) was used for long-term assessment. Lameness, posture, and pain were assessed at perioperative (0-3 months), short-term (3-6 months), and long-term (>12 months) intervals. Statistical analysis used non-parametric tests. A total of 13 limbs in 11 cats met the inclusion criteria. All injuries involved the tendino-osseous junction, with 7/13 (53.8%) complete ruptures. No intraoperative complications occurred. Postoperative external coaptation was used in 9/13 (69.2%) limbs (4/13 rigid splints, 5/13 soft padded) for a median duration of 6 weeks (range, 0-8 weeks). One calcaneal fracture due to implant malposition and one surgical site infection were reported at short-term follow-up. Long-term follow-up (median, 18.5 months; range, 12.1-33) showed 11/12 limbs achieving functional recovery and normal tarsal motion. Repair of Achilles tendon rupture in cats using a UHMWPE implant without rigid immobilization was associated with restoration of functional limb use, normal tarsal range of motion at long-term follow-up, and a low incidence of postoperative complications in this case series. This technique may provide a reliable surgical option for cats with AT rupture, as it may minimize the need for external fixation or external coaptation and improve short-term recovery.

A novel tension-slide double intramedullary cortical button technique for distal biceps tendon reconstruction: a case series.

Introduction:Vincula of the long head of the biceps tendon are an underrecognized entity. Very few studies have described the characteristics of symptomatic vincula following long head of biceps tendon auto-rupture or tenotomy.Materials and Methods:A retrospective case series was performed at a single institution. All patients who underwent shoulder arthroscopy and were noted to have a painful vinculum of the long head of the biceps tendon with partial or complete long head of the biceps tendon rupture between January 01, 2016, and December 31, 2020, were included. Patients were excluded if they underwent shoulder arthroplasty, open reduction internal fixation, or a glenohumeral joint stabilization procedure.Results:Eighteen consecutive patients with a long head of biceps tendon vincula noted during arthroscopy were identified. Ten patients were female (55%), with a mean age of 53 years (standard deviation [SD] 24.1). Of those with pre-operative magnetic resonance imaging available (n = 15), none reported the presence of a vinculum. Thirteen patients (72%) were found to have pathological vincula. Of these, seven patients were found to have a thickened vinculum tethering the long head of the biceps tendon. The most common reported pre-operative physical examination findings were bicipital tunnel tenderness to palpation (75%) and a positive O’Brien sign (50%). No patients experienced intraoperative or post-operative complications.Conclusion:The clinical significance of the long head of the biceps tendon vincula has not been previously described. In a subset of patients with anterior shoulder pain in the setting of long head of biceps tendon auto-rupture or prior tenotomy, a thickened long head of biceps tendon vincula can produce clinically significant symptoms of pain.

Background Chronic Achilles tendon rupture remains a challenging condition, particularly in cases involving large tendon defects that preclude end-to-end repair. Among reconstructive options, techniques using local tissues avoid the donor-site morbidity associated with tendon transfers. This study describes a modified gastrosoleus fascial turndown flap based on the Rush technique, reinforced with the plantaris tendon, and reports preliminary clinical outcomes. Methodology A total of 13 patients presenting with chronic Achilles tendon rupture (≥4 weeks) with a defect ≥6 cm were included. All underwent reconstruction using a tubularized gastrosoleus fascial flap based on the Rush principle, combined with plantaris tendon augmentation in a framing configuration. Outcomes were assessed using the Achilles Tendon Total Rupture Score (ATRS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the ability to perform heel raises. Body mass index (BMI) was analyzed descriptively as an exploratory variable, given the limited sample size precluding formal statistical analysis. Results At a mean follow-up of 16.1 ± 2.7 months, the mean ATRS was 81.0 ± 3.9, and the mean AOFAS score was 83.9 ± 2.3. Patients performed a mean of 14.5 ± 1.3 single-leg heel raises. No reruptures or complications were observed. The mean BMI was 25.2 ± 3.4 kg/m², with a slight decrease in ATRS observed in overweight patients. Conclusions The modified Rush technique with plantaris tendon augmentation appears to be a reproducible biological option for the management of chronic Achilles tendon ruptures with large defects. In this preliminary series, satisfactory functional outcomes were observed, supporting the feasibility of a fully biological reconstruction strategy using local tissues without tendon sacrifice. This approach may represent a potential alternative to tendon transfers for defects ≥6 cm.