Achilles tendon rupture

NewsBot · Apr 25, 2025

Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair
Ronny Lopes et al
Source

Background:
The Ankle-GO is a composite outcome score based on 4 functional tests and 2 patient-reported outcome measures. It was initially described and validated for its ability to predict return to sports (RTS) at the same level of play after lateral ankle sprains.
Purpose/Hypothesis:
The main aim of this study was to assess the psychometric properties of the Ankle-GO in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict RTS at the same level of play. It was hypothesized that this composite outcome score is a valid and reliable tool that is able to discriminate and predict the level of RTS at 9 months after Achilles tendon repair.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
This was a prospective multicenter study. Patients who were active in sports and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 participants with no history of lower limb injuries was also evaluated. After standard rehabilitation for the first 2 months, the Ankle-GO was administered at 6 and 9 months after repair by the same experienced physical therapist. During testing, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between control participants and patients at 9 months after surgery was performed.
Results:
A total of 50 patients (24 women and 26 men), with a mean age of 38.3 ± 10.1 years, were included. No patients were lost to follow-up at 9 months. The Ankle-GO score at 6 months was 10.7 ± 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum score achieved was 3 points (n = 5 [10%]). Only 1 patient (2%) obtained the maximum score (25 points). There was a significant difference in the Ankle-GO score between patients at 6 and 9 months and between control participants and patients at 9 months after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to their preinjury level of sport at 9 months. The ability of the Ankle-GO score at 6 months to predict RTS at the preinjury level at 9 months was good (area under the curve = 0.71 [95% CI, 0.56-0.85]; P < .01). A Youden index of 0.42 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.
Conclusion:
The Ankle-GO is a valid tool to evaluate and discriminate patients during the RTS continuum after Achilles tendon repair and to predict RTS at the same level at 9 months after surgery. This composite outcome score assesses ankle function and the patient’s psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of a recurrence.
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NewsBot · Apr 26, 2025

The top 50 most cited articles on minimally invasive Achilles tendon repair: a bibliometric analysis
Darcy Ottomanelli et al
Eur J Orthop Surg Traumatol. 2025 Apr 25;35(1):168.

Purpose: Achilles tendon rupture is an increasingly common injury seen in athletic and active populations which can be corrected through strategic operative techniques. The purpose of this study is to identify and review the top 50 most cited articles discussing minimally invasive Achilles tendon repair with regards to the operative technique, outcomes, and complications.

Methods: Scopus database was used to search for publications focusing on minimally invasive Achilles tendon repair. The top 50 most cited articles were screened for inclusion criteria and reviewed for year published, journal of publication, country of origin, study type, level of evidence, and citation density.

Results: The total number of citations from the top 50 most cited articles was 1,415 with a range of five to 168 citations per article. The year of publication ranged from 2004 to 2020, with the majority (n = 33) being published from 2010 to 2020. The most common level of evidence rating was III (25 articles), most of which were cohort studies. The next most common level of evidence rating was IV (11 articles), which were mostly case series. The articles were written across 18 countries, most commonly the United Kingdom (18%), and were published in 28 journals with Foot and Ankle International being the most prolific journal (n = 8).

Conclusion: The results of this study highlighted the prevalence of cohort studies, case series, and technical notes for minimally invasive Achilles tendon repair research. This demonstrates the need for more research with higher level, controlled studies to examine minimally invasive Achilles tendon repair techniques, outcomes, and complications in the future.
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NewsBot · Apr 26, 2025

Systematic Review and Meta-Analysis Comparing Open FHL Tendon Transfer, Hamstring Transfer, and Turndown Flaps to Treat Chronic Achilles Tendon Ruptures
Bedri Karaismailoglu et al
Source

Background:
Chronic Achilles tendon ruptures (CATRs) present significant challenges because of delayed diagnosis and more complicated salvage treatments that can result in unfavorable outcomes and increased rates of adverse events. Various reconstructive surgical options have been described, each with its own unique advantages and disadvantages. Comprehensive comparison of these techniques, however, is lacking. This meta-analysis aimed to compare clinical outcomes following 3 of the most commonly used salvage techniques including flexor hallucis longus (FHL) transfer, hamstring transfer, and gastric-soleal turndown flap.
Methods:
This systematic review adhered to PRISMA guidelines and included studies registered on PROSPERO. Searches were conducted across multiple databases, and eligibility criteria encompassed studies reporting on clinical scores and complications following surgical treatment of CATRs with FHL transfer, hamstring tendon transfer, or turndown flaps. Data extraction, quality assessment, and statistical analyses were performed following standardized protocols.
Results:
Among 1910 identified studies, 25 met inclusion criteria with 11 focusing on FHL transfer, 9 on hamstring tendon transfer, and 6 on turndown flap management. A meta-analysis revealed variations in patient demographics, surgical techniques, and rehabilitation protocols across the 3 intervention groups. Although the mean improvement in American Orthopaedic Foot & Ankle Society scores was comparable (38.9 for turndown flap, 31.8 for FHL transfer, and 26.0 for hamstring transfer), complication rates differed significantly. The turndown flap group exhibited the highest overall complication rate, particularly because of wound-related complications, with a wound complication rate of 12.5%, compared with 5.7% for FHL transfer and 3.5% for hamstring transfer.
Conclusion:
This study underscores the challenge of evidence-based decision making in the surgical management of CATRs. Despite apparently similar functional outcomes, the choice of open surgical technique affects complication rates. Turndown flaps, although effective in restoring musculotendinous continuity, carry higher risks of wound complications compared with the other techniques evaluated.
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NewsBot · Apr 28, 2025

Postoperative Complications After Acute Achilles Tendon Rupture Repair: A Survival Analysis of Minimally Invasive vs Open Techniques
Joris R H Hendriks et al
Foot Ankle Int. 2025 Apr 28:10711007251333777.

Background: The complication rates after surgical repair of acute Achilles tendon ruptures (ATRs) using open repair or minimally invasive surgical techniques (MIS) have been debated extensively. Despite significant research, a literature hiatus exists on the timing of these complications between techniques. In this study, we aimed to address this gap by conducting a Kaplan-Meier survival analysis to compare the incidence and timing of complications after open vs MIS repair of acute ATRs and examine associated risk factors.

Methods: This retrospective study included patients ≥18 years who underwent surgical treatment of an acute ATR within 28 days of injury and had a minimum of 90-day follow-up. Demographics, surgical technique (open vs MIS repair), and the occurrence and timing of postoperative complications were collected. Postoperative complications were classified as venous thromboembolism, rerupture, surgical site infection, wound dehiscence, and sural nerve injury. A Kaplan-Meier curve was employed to compare the complication rates between groups. The log-rank test was used to test the equality of survivor functions. The Cox proportional hazards model was used to determine predictors of complications.

Results: In total, out of 417 patients, 52 complications were reported in 50 patients. We found no significant difference in the complication rates between the MIS and open repair groups. Cox proportional hazards modeling revealed that BMI was a significant predictor of rerupture (HR 1.2, 95% CI 1.05-1.4) and that surgical delay increased the risk of wound dehiscence (HR 1.2, 95% CI 1.01-1.3) and sural nerve injury (HR 1.2, 95% CI 1.1-1.3).

Conclusion: MIS and open repair techniques for acute ATRs demonstrate comparable complication rates. However, patients with elevated BMI exhibit a modest increased risk of rerupture, regardless of the technique used. Those with surgical delay beyond 2 weeks are also modestly more likely to experience wound dehiscence with open surgical approach and sural nerve injury among MIS-treated patients.
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NewsBot · Apr 28, 2025

Shear Wave Tensiometry in the Evaluation of Achilles Tendon Loading: A Cross-Sectional Study on Conservatively Treated Tendons After Rupture
Alessandro Schneebeli et al
J Foot Ankle Res. 2025 Jun;18(2):e70047.

Purpose: The aim of this study was to quantify differences in the shear wave speed (SWS) between a conservatively treated Achilles tendon (AT) after rupture and the unaffected contralateral tendon.

Methods: Twenty-nine participants who received conservative treatment following Achilles tendon rupture (ATR) were enrolled. Measurements were taken during a single follow-up visit, which occurred between 1 and 7 years after the rupture. Tendon load was assessed using a shear wave tensiometer comprising a set of four accelerometers attached to the tendon. Stiffness, thickness, and cross-sectional area (CSA) were also assessed using MyotonPRO and ultrasound imaging.

Results: No significant differences in SWS were found between the affected AT and the unaffected side when analyzing the entire group (p > 0.05). However, significant differences between sides were observed at 3.5 Nm and 7 Nm (p = 0.001 and p = 0.020) for participants that experienced a lesion of the mid tendon. Higher plantar flexor strength was found for the unaffected side (320 ± 99.5 Nm) compared to the affected side (261 ± 80 Nm; p = 0.001). Thickness and CSA in the proximal and distal part of the tendon were significantly higher in the affected tendon compared to the unaffected side (p < 0.001).

Conclusion: There is no difference in SWS values between the affected and the unaffected AT in the longer term after the rupture. However, differences in SWS were detected at specific contraction levels in participants with a mid-tendon lesion. Moreover, tendon thickness and the cross-sectional area, as well as plantar flexor strength, remain different between the affected and the unaffected AT.
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NewsBot · May 28, 2025

Outcomes of the Mini-Open Technique for Achilles Tendon Repair: An Updated Systematic Review
Jimmy Wen et al
Source

There is much debate regarding the optimal treatment for acute Achilles tendon rupture. Surgical repair consists of open repair, percutaneous repair, and mini-open repair. The purpose of this review is to evaluate studies reporting outcomes after mini-open Achilles tendon repair (ATR) through evaluation of return to activity (RTA), complication rates, and postoperative patient-reported outcomes (PROs). A systematic review search following the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed in three databases for studies including mini-open ATR. Study variables included title, author, publication date, study year, number of patients/Achilles, mean age, mean follow-up time, time to RTA/return to sport (RTS)/return to work (RTW), PROs, and rates of complications. Twenty-five studies, including 957 patients with a mean age of 39.34 ± 6.84 years and a mean follow-up time of 29.48 ± 17.64 months, were included in this study. The overall rates (range) of RTA (eight studies), RTS (12 studies), and RTW (eight studies) were 96.46% (82.3%-100%) at four months (3.8-7), 92.7% (82.3%-100%) at 5.4 months (4.3-6.1), and 100% at 2.2 months (0.6-4.5), respectively. The mean postoperative PROs of the American Orthopedic Foot and Ankle Score (11 studies), Achilles Tendon Total Rupture Score (eight studies), and Visual Analog Pain (four studies) were 95.5 (90.1-99.2), 90.3 (86-94.6), and 3.35 (0.2-8.85), respectively. The overall complication rate for mini-open repair was 8.05%, with the most common being sural nerve injury, rerupture, and skin adhesions. The mean rates of sural nerve injury and rerupture were 1.67% and 1.25%. Patients undergoing mini-open ATR demonstrated high rates of return to baseline activity, low rates of complications, and excellent postoperative PRO scores. Mini-open repair is a reliable technique with comparable functional outcomes to traditional open repair, with lower rates of infections and wound healing issues.
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NewsBot · Jun 4, 2025

Endoscopic flexor hallucis longus transfer for acute Achilles tendon ruptures is associated with a high re-rupture rate: A prospective case series
Tiago Soares Baumfeld et al
Foot and Ankle Surgery 3 June 2025

Introduction
Achilles tendon rupture (ATR) is one of the most common injuries to the musculoskeletal system. Recently, endoscopic FHL transfer has been successfully used to treat acute injuries in soccer players, with good return to play rates and good functional outcomes. The aim of this study is to analyze patient-reported questionnaires, functional capacity assessment (FCA), and re-rupture rates following endoscopic FHL transfer for acute ATR.
Methods
This is a prospective case series with 26 patients (15 men, 11 women, mean age 47.7 years) who suffered an ATR and underwent surgical reconstruction with a FHL endoscopic transfer, between March 2022 and December 2023. The minimum follow-up was 12 months. Postoperative assessments included the visual analogue pain scale (VAS), Victorian Institute of Sports Assessment – Achilles (VISA-A) score, Achilles total tendon rupture score (ATRS), AOFAS, EVA, as well as plantar flexion strength, hallux flexion strength, ankle mobility, single heel rise test and Lunge test and Achilles tendon resting angle.
Results
Five out of 26 patients (19,2%) had a re-rupture of the Achilles tendon between the second and the fourth postoperative week. Twelve months postoperatively, the pain measured by VAS was 0.5, the mean VISA-A score was 94.4 (95% CI: 90.8–100), and the mean ATRS was 5.1. The plantar flexion strength and ankle mobility were significantly lower in the affected side when compared to the formerly unaffected side (p = 0.015 and p < 0.001, respectively). No wound healing problems or neurovascular or complications were observed.
Discussion
Despite a cautious rehabilitation program, we observed an unacceptably re-rupture rate of 19.2% in our sample when compared to other techniques. We therefore believe that this technique should not be used in very active patients who desire fast recovery after acute ATR because the risks may be too high.
Conclusion
Endoscopic FHL transfer appears to be associated with a high re-rupture rate when used to treat acute Achilles tendon ruptures.
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NewsBot · Jun 10, 2025

Functional outcome and correlation with ultrasound gap size of Achilles tendon rupture treated non-operatively with boot and wedges
Rohit Ravindran Nair et al
J Orthop. 2025 Feb 1:68:105-108.

Background: The need for surgical management of Achilles tendon ruptures has been decreasing due to a better understanding of their non-operative management. The primary aim of our study was to assess the functional outcome of Achilles tendon ruptures treated with fixed angle walking boots with wedges (FAWW) and its relationship with gap size, functional scores, single leg heel raise height difference (HHD) and calf circumference difference (CCD). The secondary aim was to look at the complication rates.

Methods: 34 patients (29 males and 5 females), who presented with acute Achilles tendon ruptures to Blackpool Teaching Hospitals NHS Foundation Trust from October 2020 to April 2022, were treated with an equinus slab for 2 weeks followed by a fixed angle boot, with wedges being sequentially removed every 2 weeks. They were reviewed at 3, 6 and 12 months. At each visit, Achilles Tendon Rupture score (ATRS), HHD and CCD were measured. Any complication, such as deep vein thrombosis (DVT) or re-rupture, was recorded.

Results: The mean age group of patients was 50 years (28-87 years). The average ATRS at 3, 6 and 12 months were 29.84, 61.68 and 76, respectively. The mean HHD was 8.9 centimetres (cm) at 3 months, 3.79 cm at 6 months and 2.4 cm at 12 months. The mean CCD was 1.31 cm at 3 months, 0.88 cm at 6 months and 1.07 cm at 12 months. We did not find a significant correlation between Achilles tendon gap size measured by ultrasound and ATRS, HHD and CCD in our study.

Conclusions: Non-operative management of Achilles tendon ruptures with boot and wedges gives a good functional outcome, which has no relationship with tendon gap size at the time of initial rupture.
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NewsBot · Jun 11, 2025

Affordable approach using flexor hallucis longus muscle graft for chronic Achilles tendon rupture: A case report
Romy Deviandri et al
International Journal of Surgery Case Reports 4 June 2025, 111470

Highlights
• A chronic Achilles tendon rupture should be repaired to improve patient's quality of life.
• FHL muscle grafting is cost-effective procedure.
• A grafting approach using FHL muscle is more applicable in remote area hospital.
• Foot and Ankle Disability Index (FADI) and Visual Analog Scale (VAS) can be used to evaluate the outcome.
Introduction and importance
The Achilles tendon is vital in maintaining balance when walking. An affordable approach using the flexor hallucis longus (FHL) tendon graft is a cost-effective treatment.
Case presentation
A 35-year-old male who worked as a porter was taken to the clinic after falling while going downstairs a year ago. The physical examination showed gastrocnemius muscle atrophy and limited range of motion (ROM). The Thompson test was performed, and the result was positive for the Achilles tendon rupture (ATR).
Clinical discussion
Various techniques could be used in a chronic Achilles case, including autograft and allograft. Because the gap was 5.5 cm, we implemented a suitable surgical approach using an FHL tendon graft to repair a chronic ATR. The Euroqol 5-Dimension (EQ5D), the Visual Analog Scale (VAS), the Foot and Ankle Disability Index (FADI), and the cost-effectiveness (CEA) were measured to follow up patients' outcomes.
Conclusion
A grafting procedure using the FHL tendon was affordable and cost-effective for reconstructing a chronic ATR. This technique was preferable, especially in remote area hospitals.
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NewsBot · Jun 13, 2025

Clinical Outcome of Achilles Tendon Rupture
Repaired by a Modified Minimally Invasive
Percutaneous Suturing
Xiaoyang Qi et al
Source

Purpose: Minimally invasive percutaneous techniques offer a promising alternative to open surgical repair of the Achilles tendon.
However, the possibilities of recurrent rupture and nerve complications remain. Hence, the present study was conducted to describe
a modified repair technique for the Achilles tendon able to overcome these limitations.
Patients and Methods: This retrospective study included 36 patients with acute closed Achilles tendon rupture treated at our
institution between January 2020 and January 2022. All patients underwent surgery at our institution and were followed up for 12–25
months. Functional evaluation was based on the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and
the Achilles tendon total rupture score (ATRS), along with local complications.
Results: None of the patients had sural nerve injury, infection or re-rupture at a minimum follow up of 12 months. At the final followup, the average AOFAS ankle-hindfoot score and ATRS were 95.5 and 90.0, respectively. The final magnetic resonance imaging
showed continuity and thicker regeneration of the tendon.
Conclusion: The modified percutaneous repair of the Achilles tendon is an effective procedure which yields good functional outcome
with few complications, and it could be widely promoted in clinical practice.
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NewsBot · Jun 13, 2025

Pivoting from Nonoperative to Operative Management After Achilles Tendon Re-Rupture: A Case Report
Source

BACKGROUND: Achilles tendon rupture incidence has been increasing over the past several decades with management including nonoperative and operative options. Little is known regarding the patient experience in those who transition from nonoperative to operative management due to re-rupture.

CASE PRESENTATION: 22-year-old male physical therapy student who heard a “pop” while playing soccer. Per ultrasound imaging findings and patient goals, he trialed nonoperative management. However, he experienced re-rupture and underwent open Achilles tendon repair.

OUTCOME AND FOLLOW-UP: After rehabilitation, he demonstrated normalized heel-rise endurance, quadriceps and hamstring strength. He lacked heel-rise height compared to contralateral side. He resumed recreational running and lifting, but not sports.

DISCUSSION: Initial nonoperative management after Achilles tendon rupture does not appear to diminish outcomes after subsequent Achilles tendon repair. However, the patient reported heightened fear of re-rupture after nonoperative management and relief with operative management.
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NewsBot · Jun 14, 2025

Clinical outcome of adding injection of freeze-dried platelet-derived factor concentrate to operative treatment accompanied by an early rehabilitation for Achilles tendon rupture in high-level athletes
Shota Morimoto et al
Regen Ther. 2025 May 28:30:107-111.

Background: Achilles tendon ruptures (ATRs) often occur in competitive athletes. Various studies have been conducted to improve the treatment outcomes for ATRs, but the results remain unsatisfactory for athletes.

Purpose: To review our experiences of adding injections of freeze-dried platelet-derived factor concentrate (FD-PFC) to surgical treatment with an early rehabilitation for ATRs in high-level athletes.

Methods: We retrospectively analyzed 8 high-level athletes (Tegner activity score ≥8) with ATR, who received postoperative injection of FD-PFC in addition to surgical treatment with an early rehabilitation protocol between May 2019 and November 2021. In all patients, surgery was performed using the modified side-locking loop suture technique, and an early rehabilitation protocol was implemented postoperatively. The prepared FD-PFC was injected into the Achilles tendon suture site under ultrasound guidance at 4 weeks postoperatively. Evaluation of the clinical outcomes included the following factor: the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) score measured preoperatively and at one year postoperatively, time to ability to perform 20 continuous double- and single-leg heel raises (DHR/SHR), time to return to the original sport, and complications related to surgery or FD-PFC injection. In addition, magnetic resonance imaging (MRI) was performed for all patients at 12 and 24 weeks postoperatively to evaluate Achilles tendon maturation.

Results: The 8 patients consisted of 7 males and one female athletes with a mean age of 28.5 ± 5.2 years (range, 23-39 years) at the time of surgery. All patients were high-level athletes with a mean Tegner activity score of 9.0 ± 0.5 (range, 8-10). The mean AOFAS score improved significantly from 36.0 ± 9.4 preoperatively to 96.8 ± 3.6 at one year postoperatively (p < 0.001). The mean time to be able to perform 20 continuous DHR and 20 continuous SHR was 6.8 ± 0.8 weeks and 10.1 ± 1.6 weeks, respectively. All patients could return to their original sport at pre-injury levels with the mean time of 18.3 ± 2.7 weeks. Also, there were no complications related to surgery or injection. Furthermore, T2-weighted MRI showed the high signal intensity of the sutured tendon in 25 % (2 of 8 patients) at 12 weeks and 0 % (0 of 8 patients) at 24 weeks postoperatively.

Conclusions: The addition of FD-PFC injections to surgical treatment with an early rehabilitation protocol could provide satisfactory results for high-level athletes with ATRs, enabling them early return to their original sports at pre-injury level. This treatment option may be useful for athletes with ATRs
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NewsBot · Jun 14, 2025

The impact of Achilles tendon thickness and Kager's fat pad thickness on clinical and functional outcomes following open surgical repair of acute Achilles tendon rupture
Bilge Kagan Yılmaz et al
Ulus Travma Acil Cerrahi Derg. 2025 Jun;31(6):587-595.

Background: Acute Achilles tendon ruptures (ATR) are among the most common sports-related injuries. The aim of this study was to evaluate the correlation between Achilles tendon (AT) and Kager's fat pad (KFP) thickness with clinical and functional outcomes, measured using the Achilles Tendon Rupture Score (ATRS) and the Foot and Ankle Outcome Score (FAOS), in patients treated with open surgical repair for acute ATR.

Methods: This retrospective study included 42 patients who underwent surgery for ATR at our institution between January 2017 and December 2021. All patients were treated using the open surgical Krackow suture technique. ATRS, FAOS, and Visual Analogue Scale (VAS) scores were recorded one year postoperatively. AT and KFP thicknesses were measured via ultrasonography by an independent radiologist at one-year follow-up.

Results: The mean age of the patients was 45.38+-9.68 years, with 22 male patients (52.4%). The mean ATRS was 65.17+-24.46, the mean FAOS was 76.14+-16.75, and the mean VAS score was 3.02+-1.44. The mean AT thickness on the operated side was 15.54+-2.89 mm, compared to 14.58+-2.28 mm on the contralateral side (p=0.009). The mean KFP thickness on the operated side was 8.42+-2.99 mm, compared to 6.32+-2.67 mm on the contralateral side (p=0.005). A strong correlation was found between ATRS and FAOS (r=0.742, p<0.001). For AT thickness, there were moderate negative correlations with both ATRS and FAOS (r=-0.544, p=0.013; r=-0.451, p=0.003, respectively). For KFP thickness, a moderate negative correlation was found with ATRS (r=-0.506, p=0.001).

Conclusion: AT and KFP thicknesses had no significant direct effect on ATRS and FAOS. However, ATRS and FAOS scores following open surgical repair of acute ATR were correlated with each other and with functional outcomes. Despite its specific complications, open surgical repair of acute ATR is an effective option for patients eligible for surgery.
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NewsBot · Jun 14, 2025

Endoscopic flexor hallucis longus transfer for acute Achilles tendon ruptures is associated with a high re-rupture rate: A prospective case series
Tiago Soares Baumfeld et al
Foot Ankle Surg. 2025 Jun 3:S1268-7731(25)00126-2.

Introduction: Achilles tendon rupture (ATR) is one of the most common injuries to the musculoskeletal system. Recently, endoscopic FHL transfer has been successfully used to treat acute injuries in soccer players, with good return to play rates and good functional outcomes. The aim of this study is to analyze patient-reported questionnaires, functional capacity assessment (FCA), and re-rupture rates following endoscopic FHL transfer for acute ATR.

Methods: This is a prospective case series with 26 patients (15 men, 11 women, mean age 47.7 years) who suffered an ATR and underwent surgical reconstruction with a FHL endoscopic transfer, between March 2022 and December 2023. The minimum follow-up was 12 months. Postoperative assessments included the visual analogue pain scale (VAS), Victorian Institute of Sports Assessment - Achilles (VISA-A) score, Achilles total tendon rupture score (ATRS), AOFAS, EVA, as well as plantar flexion strength, hallux flexion strength, ankle mobility, single heel rise test and Lunge test and Achilles tendon resting angle.

Results: Five out of 26 patients (19,2 %) had a re-rupture of the Achilles tendon between the second and the fourth postoperative week. Twelve months postoperatively, the pain measured by VAS was 0.5, the mean VISA-A score was 94.4 (95 % CI: 90.8-100), and the mean ATRS was 5.1. The plantar flexion strength and ankle mobility were significantly lower in the affected side when compared to the formerly unaffected side (p = 0.015 and p < 0.001, respectively). No wound healing problems or neurovascular or complications were observed.

Discussion: Despite a cautious rehabilitation program, we observed an unacceptably re-rupture rate of 19.2 % in our sample when compared to other techniques. We therefore believe that this technique should not be used in very active patients who desire fast recovery after acute ATR because the risks may be too high.

Conclusion: Endoscopic FHL transfer appears to be associated with a high re-rupture rate when used to treat acute Achilles tendon ruptures.
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NewsBot · Jun 16, 2025

Examining prior injury relative to Achilles tendon ruptures in National Basketball Association players
Adam J. Petway,Reuben F. Burch,David Saucier,Zachary M. Gillen,Scott Epsley,Randy Forbes
Research in Sports Medicine

The purpose of this study is to examine Achilles Tendon (AT) rupture and prior injury in the National Basketball Association (NBA). Publicly available data was sourced via two online databases and filtered to identify those reported as having sustained AT rupture. A full injury history was then generated for those players. A total of 51 AT ruptures were identified. Thirty-five per cent (18) had previously missed at least one game for “Achilles tendinitis” or “Achilles tendon injury” on the side of the affected limb. A further 18% were noted to have suffered plantar fasciitis or foot inflammation (9) or previous ankle injury (9). Seven previous injuries were knee related, and five were described as calf muscle injuries. The remaining three had prior soft tissue injuries to the quadriceps, hamstring or groin. Understanding any potential association between previous small time-loss injuries and large time-loss injuries such Achilles tendon ruptures is an important step in advancing injury risk mitigation strategies in professional basketball.
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NewsBot · Jun 16, 2025

Acute Achilles Tendon Rupture: How Well Can Artificial Intelligence Chatbots Answer Patient
Wojciech K Dzieza et al
Front. Digit. Health Volume 7 - 2025 | doi: 10.3389/fdgth.2025.1614344

Objectives: Artificial intelligence (AI) chatbots have gained popularity as a source of information that is easily accessed by patients. The best treatment of acute Achilles tendon ruptures (AATR) remains controversial due to varying surgical repair techniques, postoperative protocols, nonoperative treatment options, and surgeon and patient factors. Given that patients will continue to turn towards AI for answers to medical questions, the purpose of this study is to evaluate whether popular AI engines can provide adequate responses to frequently asked questions regarding AATR. Methods: Three AI engines (ChatGPT, Google Gemini, and Microsoft Copilot) were prompted for a concise response to ten common questions regarding AATR management. Four board-certified orthopaedic surgeons were asked to assess the responses using a four-point scale. A Kruskal-Wallis test was used to compare the responses between the three AI systems using the scores assigned by the surgeons. Results: All three engines provided comparable answers to 7 of 10 questions (70%). Significant differences were noted between the AI systems for three of the ten questions (Question 4, overall p=.027; Question 7, overall p=.043; and Question 10, overall p=.033). Post-hoc analyses revealed that Copilot received significantly poorer scores (higher mean ratings) compared to Gemini for Question 4 (adjusted p=.028) and Question 7 (adjusted p=.036), and poorer score compared to ChatGPT for Question 10 (adjusted p=.033). Conclusions: AI chatbots can appropriately answer concise prompts about diagnosis and management of AATR. The responses provided by the three AI chatbots analyzed in our study were largely uniform and satisfactory, with only one of the engines scoring lower on three of the ten questions. As AI engines advance, they will become an important tool for patient education in orthopaedics.
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NewsBot · Jun 18, 2025

Translation, cultural adaptation and validation of the Achilles Tendon Total Rupture Score (ATRS) into Spanish: a study protocol
Armando Calleja-Rodríguez et al
Source

The Achilles tendon is the strongest and largest tendon in the human body, yet it is also the most frequently ruptured. The incidence of Achilles tendon rupture (ATR) is increasing due to an ageing population, rising obesity rates and greater sports participation. The Achilles Tendon Total Rupture Score (ATRS) is a validated patient-reported outcome measure widely used to assess clinical and functional outcomes after ATR. However, there is no culturally adapted and validated Spanish version of this tool, limiting its applicability in Spanish-speaking populations. The aim is to translate, culturally adapt and validate the Spanish version of the ATRS following international guidelines and to analyse its psychometric properties for assessing clinical and functional outcomes in patients with ATR. This study protocol outlines a cross-sectional design adhering to Strengthening the Reporting of Observational Studies in Epidemiology and Checklist for Reporting Results of Internet E-Surveys guidelines for observational studies and online surveys. The ATRS will be translated and culturally adapted, psychometric analysis will follow COnsensus-based Standards for the selection of health Measurement INstruments standards, including reliability, validity and sensitivity assessments. Participants will include patients treated surgically for ATR in hospitals across Madrid and healthy controls recruited through social media. Sociodemographic, clinical and functional data will also be collected to support the validation process. This study protocol was approved by the Universidad Europea de Madrid Institutional Board (Approval ID: CI 2024/897) prior to data collection based one the Declaration of Helsinki. The study’s findings will be distributed to athletes, physicians and academics via peer-reviewed publications and national/international conferences.
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NewsBot · Jun 19, 2025

REHABILITATION STRATEGIES FOLLOWING ACHILLES TENDON RUPTURE
Gavril GHEORGHIEVICI et al
Romanian Journal of Medical Rehabilitation, Volume 2, Issue 1

Introduction: The Achilles tendon, the most robust tendon in the body, still remains susceptible to injury. The
purpose of this review is to address the existing knowledge gaps regarding the comparative effectiveness of surgical and non-
surgical interventions for tendon ruptures, in order to identify superior functional outcomes encompassing rehabilitation protocols.
Materials and Methods: We performed a comprehensive search strategy across multiple electronic databases, including PubMed,
Web of Science, Elsevier, The Cochrane Library, Pedro. Articles containing data regarding rehabilitation following Achilles
tendon rupture along with relevant literature evidencing the use of adequate protocols were included for analysis. Results and
Discussions: Achilles tendon rupture is intricately linked to diverse risk factors. Among sports-related determinants, inadequate
conditioning, overexertion, and engagement in activities such as soccer, basketball, and racquet games can increase vulnerability.
The main objective of a rehabilitation program is focused on safeguarding the surgical repair, preserving hip, knee, and core
strength, and address swelling. By the end of week 12, the rehabilitation objectives include continued repair protection, avoiding
Achilles over-elongation, normalizing gait and restoring full range of motion. The last stages of the rehabilitation process, require
the use of tendon loading exercises in order to gradually promote return to daily activities. Conclusions: The rehabilitation period
is a dynamic process that enables an individualized approach. The integration of progressive rehabilitation programs represents
an important step in promoting adequate tissue healing and restoring proper function
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NewsBot · Jun 22, 2025

Mechanisms of Achilles Tendon Rupture in the Normal Population Free
N Limaye , L Andritsos , J Aamir , D Scarffe , P Goudie , A Molloy , L Mason
British Journal of Surgery, Volume 112, Issue Supplement_10, June 2025, znaf128.680, https://doi.org/10.1093/bjs/znaf128.680

Aim

Published research with regards to Achilles tendon rupture (ATR) is mainly based on athlete or military populations, which may not correlate to the general population. Main aim of this study is to explore mechanisms of ATR of patients presenting to a single ATR clinic. Null hypothesis assumes there is no correlation between mechanism of injury and occupational activity classification.
Method

This study retrospectively reviewed a database of prospectively collected information on ATRs of 238 patients. Inclusion criteria included patients with ATR between years 2020-2023. Patients were analysed for demographics, rupture mechanism, comorbidities, risk factors and occupational activity classification.
Results

Out of 238 patients, 10(4.69%) ruptured their Achilles tendon due to fall from height, 24(11.27%) due to walking, 34(15.96%) due to simple fall, 2(0.94%) undergoing physio and 1(0.47%) pushing/lifting. Sport was responsible for 142(66.67%) injuries with football causing 78(53.79%) injuries and running 19(13.10%). The average age of patients who ruptured their tendon due to sport was 42.29. 74.37% were males. The majority (49.25%) of all ruptures were in low activity occupations, with 63.95% of all sport-related ruptures being in the low activity group as well.
Conclusions

This study has concluded sport plays the biggest role in Achilles tendon rupture, but not to the same level as seen in military and athlete populations. The data based around occupational activity classification, demographics and mechanisms of injury demonstrates that most patients are male, in the older age group and have low occupational activities.
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NewsBot · Jun 23, 2025

Heel width as a simple parameter to prevent sural nerve entrapment during percutaneous Achilles tendon repair
Łukasz Kuligowski, Piotr Sibiński, Marcin Sibiński
Source

Background.
The aim of the research was to evaluate a simple parameter that could prevent sural nerve (SN) entrapment during percutaneous acute Achilles tendon (AT) repair. The parameter could be easily introduced during surgery, would not raise the costs of procedure and could be universally used by any orthopedic surgeon.

Methods.

A number of 28 fresh male cadavers were used to identify the crossing point between the medial margin of the SN and the lateral margin of the AT, proximally from the calcaneal tuberosity (CT). The following measurements were taken: shin length, heel width, foot length and AT width 16 cm from CT.

Results.

A significant relationship was found between heel width and the crossing point of CT with AT (p = 0.04). The distance from the crossing point was not related to shin length, foot length, AT width 16 cm from CT, shin length/foot length index, shin length/heel width index, or foot length/heel width index. The linear regression model found only the estimated regression coefficient at heel width to be significant (p < 0.05), i.e. if the heel width increases by a unit (1 mm), the AT and SN crossing point increases by an average of two units (2 mm).

Conclusion.

Of the tested parameters, heel width appears to be the best predictor of SN and AT crossing point location, both with regard to significance and simplicity of use in the operation. The SN-AT junction point is located two heel widths proximal from the most prominent aspect of the CT.
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NewsBot · Jun 23, 2025

Management of Chronic Achilles Tendon Rupture with Tibialis Anterior Allograft: A 2-Year Follow-up Study
Prasad Bhagunde et al
Source

Introduction: Chronic Achilles tendon ruptures are challenging to manage, particularly in older patients. This report describes the surgical repair of a chronic rupture using a tibialis anterior allograft in a 61-year-old male, emphasizing the technique and outcomes of this approach.
Case Report: A 60-year-old male with a 3-month-old Achilles tendon rupture presented with difficulty in walking, pain, and functional impairment. Imaging revealed a 2 cm gap. Surgical management included debridement and reconstruction using a tibialis anterior allograft anchored transversally through the calcaneus. At 2 years postoperatively, the patient had a full ankle range of motion, pain-free ambulation, and restored functionality.

Conclusion: Tibialis anterior allograft is a viable option for reconstructing chronic Achilles tendon ruptures with smaller gaps in older patients. It offers reliable functional recovery while minimizing the morbidity associated with autografts.
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NewsBot · Jun 24, 2025

Evaluating Nonoperative Treatment of Achilles Tendon Ruptures Within the Military Health System
Dalessandro, Ashley et al
JBJS Journal of Orthopaedics for Physician Assistants 13(1)

The management of Achilles tendon ruptures continues to be a debated topic. Despite the recent trend toward nonoperative management, research focusing on nonoperative management outcomes is scarce. Research regarding risk factors of prolonged recovery in nonoperatively treated patients is even more limited. Our study is a retrospective, single-cohort study that evaluated if there is a statistically significant difference in patient and treatment characteristics in average recovery vs. prolonged recovery in nonoperatively treated Achilles tendon ruptures. We hypothesized that there is a statistically significant difference in duration of immobilization in the average recovery group vs. patients in the prolonged recovery group in nonoperatively treated Achilles tendon ruptures. Secondarily, we hypothesized that there is a statistically significant difference in patient and treatment characteristics in terms of when patients start physical therapy (PT) after injury, presence of comorbidities, and nicotine use in average recovery vs. prolonged recovery groups in nonoperatively treated Achilles tendon ruptures. To test these hypotheses, we evaluated patients treated nonoperatively for an Achilles tendon tear within the Military Health System from June 2017 to December 2022. Our study found that the duration of immobilization, the duration of time from the date of injury to start of PT, and number of PT appointments were each statistically significant in predicting the return-to-activity (RTA) time (p < 0.03). Our study also found that these 3 variables were all statistically significant predictors of determining if a patient would experience a prolonged RTA time (p < 0.04).
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NewsBot · Jun 24, 2025

Surgical outcomes in patients with Achilles tendon rupture—a retrospective study.
Kürüm H, Tosun HB, Aydemir F, Ayas O, Orhan Kürüm K, İpekten F.
PeerJ 13:e18890 https://doi.org/10.7717/peerj.18890

Background
There are two main methods used to treat Achilles tendon rupture (ATR): conservative treatment and surgical intervention. Surgical techniques are divided into three main categories: open surgical repair, mini-open surgical repair, and percutaneous repair (PR). We aimed to compare clinical outcomes in individuals with ATR who were treated with PR, primary repair, and flexor hallucis longus augmentation (FHL-A) with those treated with V-Y plasty and FHL-A.

Methods
The study involved 54 patients who underwent ATR surgical intervention retrospectively. Thirty-two of these were identified as acute and 22 were chronic rupture patients. PR was performed in 32 patients, primary repair and FHL-A in 14 patients, and V-Y plasty and FHL-A in eight patients.

Results
The mean forward jump was 142.69 ± 7.14 cm in individuals who received PR, 137.71 ± 4.51 cm in those who received primary repair + FHL-A, and 123.88 ± 3.09 cm in those who received V-Y plasty + FHL-A (p < 0.001). The decrease in the mean vertical jump distance on the operated side compared to the contralateral extremity was 0.97 ± 0.93, 2.07 ± 0.99, and 3.00 ± 1.69 cm in individuals who underwent PR, primary repair + FHL-A, and V-Y plasty + FHL-A, respectively (p < 0.001). The decrease in the mean dorsiflexion of the operated side ankle compared to the contralateral extremity was found to be 4.34 ± 1.18, 1.93 ± 1.07, and 2.38 ± 0.92 degrees in individuals who underwent PR, primary repair + FHL-A, and V-Y plasty + FHL-A, respectively (p < 0.001).

Conclusion
Although no surgical technique is completely superior to another, better performance tests were observed after PR repair compared to open surgery in individuals involved in sports, but rerupture, dorsiflexion restriction, and painful ankle were disadvantages. FHL-A, which has gained popularity in recent years, showed better performance in tests by contributing to more stable and stronger ankles in sporting individuals with chronic ruptures who had undergone open surgery. FHL-A can be utilized in addition to primary surgical intervention in individuals with high performance expectations before and after injury.
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NewsBot · Jun 24, 2025

Achilles Tendon Rupture Treatment Systematic Review and Meta-analysis
Sara España Fernández de Valderrama, et al
Source

Background:
Acute Achilles tendon rupture (ATR) has increased in recent decades, reflecting the longer life expectancy and higher levels of activity. Surgical intervention has been the main treatment, but recently there has been growing interest in nonoperative approaches. Study compares surgical and conservative treatment of acute ATR, examining demographic data, rerupture rate, complications, and functional scale Achilles Total Tendon Rupture Score (ATRS).
Methods:
A literature review was conducted including randomized clinical trials and prospective cohorts. RevMan software was employed to ascertain the I² heterogeneity, with a view to determining whether a fixed or random effects model should be used for meta-analysis. The results were expressed as either the mean difference or relative risk (RR), as appropriate, with 95% CI.
Results:
Ten studies, published after 2010, were included in the analysis. Of the total 1327 participants, 57.8% received surgical treatment and 42.2% nonsurgical treatment. The follow-up was between 12-24 months. The rerupture rate was lower in surgical treatment (RR 0.28, 95% CI 0.15-0.50; P < .0001), although this was accompanied by a higher risk of complications (RR 2.39, 95% CI 1.57-3.63; P < .0001). The patient satisfaction was comparable between the 2 treatment groups, with no statistically significant difference on the ATRS scale (MD 0.87, 95% CI –1.18 to 2.92; P = .40).
Conclusion:
Surgical repair of acute ATR significantly reduces the risk of rerupture but it is associated with a higher rate of complications. Furthermore, there are no significant differences in the various functional scales in terms of patient satisfaction between the 2 treatments.
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NewsBot · Jun 24, 2025

Optimization of MRI measurements of calf muscle atrophy following acute Achilles tendon rupture
Ibrahim El Haddouchi et al
Source

Objective: Investigate whether single slice cross- sectional area (CSA) measurement could be used as a surrogate for volumetric measurement on magnetic resonance imaging (MRI) in evaluating calf muscle atrophy after Achilles tendon rupture (ATR). We hypothesized that atrophy estimated by single slice CSA measurement had an R-squared (R2) value above 0.7 when compared to volumetric measurements. Methods: This was a cross-sectional study of patients one year after ATR. An MRI of both calves was performed. Muscle volume was calculated by measuring CSA of the muscles of the triceps surae and the deep flexors on axial slices every 2 cm. The limb symmetry index (LSI) was used to estimate atrophy. The two methods for assessing atrophy, single slice CSA and volumetric measurement, were compared by fitting a linear regression model and calculating the R2-value. Results: The strongest correlation was obtained when measuring CSA of the triceps surae (R2 = 0.780), soleus (R2 = 0.636), medial gastrocnemius (R2 = 0.612) and lateral gastrocnemius (R2 = 0.556) 26 cm above talus, and the deep flexors (R2 = 0.493) 14 cm above talus. Conclusions: Cross- sectional area measurement on a single MRI slice can be applied as a surrogate for volumetric measurements when investigating atrophy of the triceps surae muscle group as a whole. However, this approach is not suitable when investigating the individual parts of the muscle
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NewsBot · Jun 25, 2025

Minimally Invasive Achilles Tendon Repair: Dresden vs PARS/Knotless Techniques in a Retrospective Comparative Study
Mauro Andrés Goveo et al
Foot Ankle Int. 2025 Jun 24:10711007251341896.

Background: Minimally invasive techniques have emerged as promising options for the surgical treatment of acute Achilles tendon ruptures, aiming to reduce complication rates associated with open procedures. However, comparative data between different minimally invasive methods are limited.

Methods: In this retrospective case series, we evaluated 102 patients treated with either the Dresden or PARS/Knotless technique between January 2017 and June 2021. Clinical outcomes included time to return to sports, ankle range of motion, Achilles Tendon Total Rupture Score (ATRS), and postoperative complications. Postoperative complications were also documented.

Results: Both groups demonstrated similar rates of return to sports (91.48% PARS/Knotless vs 92.70% Dresden) and comparable ATRS scores (91.1 ± 6.7 vs 92.3 ± 8.9, P = .47). Surgical time was significantly shorter with the Dresden technique (38.3 ± 8.5 vs 43.5 ± 8.9 minutes, P = .005). The overall complication rate was significantly lower in the Dresden group (10.90% vs 29.78%, P = .024), primarily because of lower rates of calcaneodynia.

Conclusion: Although both techniques demonstrated similar functional outcomes, the Dresden procedure was associated with a lower complication rate.
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NewsBot · Jun 28, 2025

Percutaneous Repair of Acute Achilles Tendon Rupture Using Endoscopy-Assisted Krackow Suture Technique
Ali Yüce et al
Source

There are many surgical treatment methods for Achilles tendon rupture. In endoscopy-assisted percutaneous repair, tendon suturing is observable. This eliminates some of the disadvantages of percutaneous repair, especially the difficulty in assessing the contact status of the torn ends. The Krackow technique is currently the standard suture method for the open repair of Achilles tendon rupture. In this study, we aimed to describe a surgical procedure in which we observed the repair and contact of the tendon ends with the help of endoscopy and repaired the Achilles tendon with percutaneous Krackow locked sutures.
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NewsBot · Jun 29, 2025

Minimally invasive internal splinting technique for acute closed Achilles tendon rupture
Songlin Liu & Liang Ma
Journal of Orthopaedic Surgery and Research volume 20, Article number: 116 (2025)

Background

Although non-surgical and surgical approaches have been developed to repair acute closed Achilles tendon ruptures, the medical community still lacks a definitive consensus on which approach is superior. This study describes a new minimally invasive internal splinting technique combined with knotless anchors for the treatment of 22 patients with acute closed Achilles tendon rupture.
Methods

A retrospective study was conducted involving 22 patients with acute closed Achilles tendon rupture who were treated with a minimally invasive internal splinting technique at Jingzhou Hospital of Yangtze University between January 2022 to October 2023. The study recorded and compared various metrics, including the Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), Achilles tendon total rupture score (ATRS), and range of motion (ROM) of the plantar-flexor-extensor foot, both preoperatively and at the final follow-up.
Results

We bridged the intact portion of the Achilles tendon proximal to the rupture site and the calcaneal bone using a Krackow locking loop suture technique and a knotless anchor staple technique. Twenty-two patients were monitored over a period from 10 to 12 months, with an average follow-up duration of (11.6 ± 0.67) months. At the last follow-up, all patients had successfully resumed their sports activities and work without experiencing any complications, such as Achilles tendon rupture, postoperative infection, and peroneal nerve injury. The VAS score postoperatively was recorded at (0.14 ± 0.35), representing a significant reduction from the preoperative score of (4.05 ± 0.58). The AOFAS-AH score improved to (97.41 ± 4.00), a notable increase compared to the preoperative score (52.82 ± 4.43). Similarly, the ATRS score reached (98.23 ± 2.98), also significantly higher than the preoperative score (56.95 ± 4.62). Furthermore, the range of motion (ROM) was measured at (44.27 ± 1.08), significantly surpassing the preoperative value of (26.91 ± 2.09), with all differences being statistically significant (p < 0.05).
Conclusion

The procedure is simple. Two small incisions are placed over the intact proximal Achilles tendon and the calcaneus without surgical invasion of the rupture site, which promotes the natural repair of the ruptured Achilles tendon. The intact proximal Achilles tendon and the calcaneus are securely bridged with high-strength sutures and knotless anchors, reducing complications and promoting healing of the Achilles tendon.
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NewsBot · Jun 29, 2025

Functional outcome and correlation with ultrasound gap size of Achilles tendon rupture treated non-operatively with boot and wedges
Rohit Ravindran Nair et al
Journal of Orthopaedics Volume 68, October 2025, Pages 105-108

Background
The need for surgical management of Achilles tendon ruptures has been decreasing due to a better understanding of their non-operative management. The primary aim of our study was to assess the functional outcome of Achilles tendon ruptures treated with fixed angle walking boots with wedges (FAWW) and its relationship with gap size, functional scores, single leg heel raise height difference (HHD) and calf circumference difference (CCD). The secondary aim was to look at the complication rates.
Methods
34 patients (29 males and 5 females), who presented with acute Achilles tendon ruptures to Blackpool Teaching Hospitals NHS Foundation Trust from October 2020 to April 2022, were treated with an equinus slab for 2 weeks followed by a fixed angle boot, with wedges being sequentially removed every 2 weeks. They were reviewed at 3, 6 and 12 months. At each visit, Achilles Tendon Rupture score (ATRS), HHD and CCD were measured. Any complication, such as deep vein thrombosis (DVT) or re-rupture, was recorded.
Results
The mean age group of patients was 50 years (28–87 years). The average ATRS at 3, 6 and 12 months were 29.84, 61.68 and 76, respectively. The mean HHD was 8.9 centimetres (cm) at 3 months, 3.79 cm at 6 months and 2.4 cm at 12 months. The mean CCD was 1.31 cm at 3 months, 0.88 cm at 6 months and 1.07 cm at 12 months. We did not find a significant correlation between Achilles tendon gap size measured by ultrasound and ATRS, HHD and CCD in our study.
Conclusions
Non-operative management of Achilles tendon ruptures with boot and wedges gives a good functional outcome, which has no relationship with tendon gap size at the time of initial rupture.
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NewsBot · Jul 1, 2025

The top 50 most cited articles on minimally invasive Achilles tendon repair: a bibliometric analysis
Darcy Ottomanelli, Timothy Blajda, Kevin Posner & Wayne Berberian
European Journal of Orthopaedic Surgery & Traumatology

Purpose
Achilles tendon rupture is an increasingly common injury seen in athletic and active populations which can be corrected through strategic operative techniques. The purpose of this study is to identify and review the top 50 most cited articles discussing minimally invasive Achilles tendon repair with regards to the operative technique, outcomes, and complications.

Methods
Scopus database was used to search for publications focusing on minimally invasive Achilles tendon repair. The top 50 most cited articles were screened for inclusion criteria and reviewed for year published, journal of publication, country of origin, study type, level of evidence, and citation density.

Results
The total number of citations from the top 50 most cited articles was 1,415 with a range of five to 168 citations per article. The year of publication ranged from 2004 to 2020, with the majority (n = 33) being published from 2010 to 2020. The most common level of evidence rating was III (25 articles), most of which were cohort studies. The next most common level of evidence rating was IV (11 articles), which were mostly case series. The articles were written across 18 countries, most commonly the United Kingdom (18%), and were published in 28 journals with Foot and Ankle International being the most prolific journal (n = 8).

Conclusion
The results of this study highlighted the prevalence of cohort studies, case series, and technical notes for minimally invasive Achilles tendon repair research. This demonstrates the need for more research with higher level, controlled studies to examine minimally invasive Achilles tendon repair techniques, outcomes, and complications in the future.
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NewsBot · Jul 1, 2025

Popliteal Sciatic Nerve Block versus Intrathecal Anesthesia for Achilles Tendon Rupture Repair Surgery: A Mono-Centric Retrospective Comparative Study
Gao SiGao Si1Liwei WangLiwei Wang1Minzhi DengMinzhi Deng2Yihan SunYihan Sun2Yuan CaoYuan Cao1Jixing FanJixing Fan1Tengjiao ZhuTengjiao Zhu1Yun TianYun Tian1Changyi WuChangyi Wu1*Yang LvYang Lv1
Source

AbstractBackground: To compare the anesthetic and analgesic effects of popliteal sciatic nerve block and intrathecal anesthesia in acute Achilles tendon rupture patients undergoing surgery. Methods: This retrospective cohort study analyzed 115 patients with acute Achilles tendon rupture who underwent surgery at Peking University Third Hospital between May and November 2023. After excluding cases lost to follow-up or declining participation, 96 patients were ultimately enrolled. Patients were divided into two groups based on the different anesthesia methods they received: the popliteal sciatic nerve block group (BG) and the spinal anesthesia group (SAG). The anesthesia effects intraoperatively were compared between the two groups using puncture satisfaction, immediate complications of puncture, anesthesia operation time, and puncture pain evaluation. Postoperative analgesic and anesthesia recovery effects were compared between the two groups using visual analogue scale (VAS), analgesic satisfaction score, sleep score, and time to complete sensory recovery. Ankle joint mobility was used to compare postoperative motor recovery between the two groups. Results: Statistical analysis revealed that in terms of anesthesia effectiveness, the BG had a shorter anesthesia operation time (1.95±0.40min) than the SAG (7.44±1.90min), and the BG (5.4%) had fewer immediate puncture complications than the SAG (25.0%). Regarding analgesic effectiveness, the BG (4.10±0.09) had higher analgesic satisfaction compared to the SAG (3.14±0.11), and within 48 hours postoperatively, wound VAS scores in the BG were consistently lower than those in the SAG. Postoperatively, the time for complete sensory recovery in the affected lower limb in the BG (9.29±0.41h) was significantly longer than that in the SAG (6.09±0.42h). Conclusion: Compared to intrathecal anesthesia, the use of popliteal sciatic nerve block in Achilles tendon repair surgery resulted in shorter anesthesia operation time, fewer immediate puncture complications, higher patient satisfaction with analgesia, and longer duration of analgesic effect. Popliteal sciatic nerve block may be preferred for reduced complications and prolonged analgesia.
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NewsBot · Jul 6, 2025

Postoperative Complications After Acute Achilles Tendon Rupture Repair: A Survival Analysis of Minimally Invasive vs Open Techniques
Joris R. H. Hendriks et al
Source

Background:
The complication rates after surgical repair of acute Achilles tendon ruptures (ATRs) using open repair or minimally invasive surgical techniques (MIS) have been debated extensively. Despite significant research, a literature hiatus exists on the timing of these complications between techniques. In this study, we aimed to address this gap by conducting a Kaplan-Meier survival analysis to compare the incidence and timing of complications after open vs MIS repair of acute ATRs and examine associated risk factors.
Methods:
This retrospective study included patients ≥18 years who underwent surgical treatment of an acute ATR within 28 days of injury and had a minimum of 90-day follow-up. Demographics, surgical technique (open vs MIS repair), and the occurrence and timing of postoperative complications were collected. Postoperative complications were classified as venous thromboembolism, rerupture, surgical site infection, wound dehiscence, and sural nerve injury. A Kaplan-Meier curve was employed to compare the complication rates between groups. The log-rank test was used to test the equality of survivor functions. The Cox proportional hazards model was used to determine predictors of complications.
Results:
In total, out of 417 patients, 52 complications were reported in 50 patients. We found no significant difference in the complication rates between the MIS and open repair groups. Cox proportional hazards modeling revealed that BMI was a significant predictor of rerupture (HR 1.2, 95% CI 1.05-1.4) and that surgical delay increased the risk of wound dehiscence (HR 1.2, 95% CI 1.01-1.3) and sural nerve injury (HR 1.2, 95% CI 1.1-1.3).
Conclusion:
MIS and open repair techniques for acute ATRs demonstrate comparable complication rates. However, patients with elevated BMI exhibit a modest increased risk of rerupture, regardless of the technique used. Those with surgical delay beyond 2 weeks are also modestly more likely to experience wound dehiscence with open surgical approach and sural nerve injury among MIS-treated patients.
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NewsBot · Jul 6, 2025

Surgeon Preferences, Surgical Location, and Timing of Repair Drive Achilles Tendon Rupture Repair Cost
Emily B Parker et al
Foot Ankle Int. 2025 Jul 6:10711007251347278.

Background: Midsubstance Achilles tendon repair is a common procedure, yet the factors influencing its cost have been underexamined and often imprecisely understood. Using time-driven activity-based costing (TDABC), we examined variation in total cost, compared patient-, surgeon-, and surgery-specific characteristics between high- and non-high-cost repairs, and assessed factors associated with total cost to identify specific cost drivers that might reduce expenses without compromising clinical outcomes.

Methods: Patients undergoing midsubstance Achilles tendon rupture repair between January 3, 2022 and December 28, 2023 at 2 academic medical centers and their affiliated community hospitals and ambulatory surgical centers were identified. Exclusion criteria included revision procedures and those with concurrent procedures besides fasciotomy. TDABC methodology was used to determine total cost across 3 clinical phases: preoperative, intraoperative, and postoperative. Cost was normalized per institution requirements. Bivariate analysis was performed across all characteristics between high-cost (top decile) procedures and all others. Spearman correlation between operative time and total cost was assessed. Multivariable linear regression was used to identify key cost drivers.

Results: Among 341 primary midsubstance Achilles rupture repairs performed by 8 surgeons, the most expensive procedure was 6 times costlier than the least expensive one. Eighty-five percent of the cost, on average, was incurred intraoperatively. A "good" correlation was found between operative time and total cost (P < .05). When accounting for covariates, increasing time between rupture and repair was associated with higher cost (P < .05). Surgical location, surgical approach, and repair suture were also associated with total cost (P < .05).

Conclusion: Substantial variability in the cost of primary midsubstance Achilles rupture repair is driven by factors including timing of surgical repair, intraoperative surgeon-specific characteristics (ie, surgical approach and suture choice), and surgical location. Further standardization of treatment approach and decreasing time to the operating room could lower cost variability and improve the value of care for patients with midsubstance Achilles tendon rupture undergoing surgery.
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NewsBot · Jul 6, 2025

Impact of symptomatic deep vein thrombosis on self-reported function and treatment outcome following an acute Achilles tendon rupture: A register study
Jacob S. Gandløse et al
Foot and Ankle Surgery 6 February 2025

Background
Acute Achilles tendon rupture (ATR) is a common injury associated with a high rate of deep vein thrombosis (DVT) during rehabilitation. This study assessed whether DVT affects long-term self-reported function.
Methods
Data from the Danish Achilles Tendon Database were used to compare Achilles tendon Total Rupture Scores (ATRS) at 6, 12, and 24 months between patients with and without symptomatic DVT, adjusting for covariates.
Results
No significant ATRS difference between DVT and non-DVT groups was observed over time (adjusted mean difference = −0.7, 95 % CI: −4.8–3.3, p = 0.72). However, patients with DVT reported lower ATRS at 24 months (adjusted mean difference = −4.9, 95 % CI: −9.0 to −0.9, p = 0.02).
Conclusions
Symptomatic DVT is not significantly associated with self-reported function over time in patients with ATR. However, patients with DVT may experience a recovery plateau, leading to lower long-term function, though the clinical significance is unclear.
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NewsBot · Jul 10, 2025

A comprehensive review of surgical techniques for chronic Achilles tendon rupture
Yeh, Kuang-Tinga,b,c,d; Wu, Wen-Tiena,b,d; Chang, Chia-Mingb; Yu, Tzai-Chiua,b; Chen, Ing-Hob; Wang, Chen-Chiea,e,*
Tzu Chi Medical Journal 37(3) 247-254, Jul–Sep 2025. | DOI: 10.4103/tcmj.tcmj_250_24

Chronic Achilles tendon rupture (CATR) represents a significant clinical challenge, often necessitating surgical intervention to restore function, alleviate pain, and prevent long-term complications. The complex nature of CATR, characterized by tendon retraction, scar formation, and poor tissue quality, requires a tailored, evidence-based approach. This review comprehensively examines current surgical strategies for managing CATR, focusing on their indications, advantages, outcomes, and associated complications. A detailed literature search of 20 studies published between 2010 and 2023 identified key surgical techniques, including end-to-end repair, tendon transfers, autografts, synthetic grafts, and allografts. Surgical recommendations were stratified by defect size and patient factors. Small defects (<2 cm) are effectively managed with end-to-end repair or tendon transfers, offering rapid recovery and restoration of tendon continuity. Medium defects (2–5 cm) benefit from techniques such as V-Y plasty or semitendinosus autografts, providing additional length and biomechanical stability. Larger defects (>5 cm) often necessitate advanced procedures, including free tendon grafts, synthetic materials, or allografts, particularly for older patients or those with poor tissue quality. Minimally invasive techniques, such as endoscopic flexor hallucis longus transfer, have shown promise in reducing recovery times and complications. A structured decision-making framework is proposed to guide surgical choices, ensuring patient-specific, optimal outcomes. Emerging techniques further expand the possibilities for managing this challenging condition, emphasizing the need for innovation and individualized care in CATR treatment.
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NewsBot · Jul 12, 2025 at 1:07 AM

A comprehensive review of surgical techniques for chronic Achilles tendon rupture
Yeh, Kuang-Ting et al
Tzu Chi Medical Journal 37(3) 247-254, Jul–Sep 2025. | DOI: 10.4103/tcmj.tcmj_250_24

Chronic Achilles tendon rupture (CATR) represents a significant clinical challenge, often necessitating surgical intervention to restore function, alleviate pain, and prevent long-term complications. The complex nature of CATR, characterized by tendon retraction, scar formation, and poor tissue quality, requires a tailored, evidence-based approach. This review comprehensively examines current surgical strategies for managing CATR, focusing on their indications, advantages, outcomes, and associated complications. A detailed literature search of 20 studies published between 2010 and 2023 identified key surgical techniques, including end-to-end repair, tendon transfers, autografts, synthetic grafts, and allografts. Surgical recommendations were stratified by defect size and patient factors. Small defects (<2 cm) are effectively managed with end-to-end repair or tendon transfers, offering rapid recovery and restoration of tendon continuity. Medium defects (2–5 cm) benefit from techniques such as V-Y plasty or semitendinosus autografts, providing additional length and biomechanical stability. Larger defects (>5 cm) often necessitate advanced procedures, including free tendon grafts, synthetic materials, or allografts, particularly for older patients or those with poor tissue quality. Minimally invasive techniques, such as endoscopic flexor hallucis longus transfer, have shown promise in reducing recovery times and complications. A structured decision-making framework is proposed to guide surgical choices, ensuring patient-specific, optimal outcomes. Emerging techniques further expand the possibilities for managing this challenging condition, emphasizing the need for innovation and individualized care in CATR treatment.
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NewsBot · Jul 13, 2025 at 6:24 AM

Surgeon Preferences, Surgical Location, and Timing of Repair Drive Achilles Tendon Rupture Repair Cost
Emily B. Parker et al
Source

Background:
Midsubstance Achilles tendon repair is a common procedure, yet the factors influencing its cost have been underexamined and often imprecisely understood. Using time-driven activity-based costing (TDABC), we examined variation in total cost, compared patient-, surgeon-, and surgery-specific characteristics between high- and non-high-cost repairs, and assessed factors associated with total cost to identify specific cost drivers that might reduce expenses without compromising clinical outcomes.
Methods:
Patients undergoing midsubstance Achilles tendon rupture repair between January 3, 2022 and December 28, 2023 at 2 academic medical centers and their affiliated community hospitals and ambulatory surgical centers were identified. Exclusion criteria included revision procedures and those with concurrent procedures besides fasciotomy. TDABC methodology was used to determine total cost across 3 clinical phases: preoperative, intraoperative, and postoperative. Cost was normalized per institution requirements. Bivariate analysis was performed across all characteristics between high-cost (top decile) procedures and all others. Spearman correlation between operative time and total cost was assessed. Multivariable linear regression was used to identify key cost drivers.
Results:
Among 341 primary midsubstance Achilles rupture repairs performed by 8 surgeons, the most expensive procedure was 6 times costlier than the least expensive one. Eighty-five percent of the cost, on average, was incurred intraoperatively. A “good” correlation was found between operative time and total cost (P < .05). When accounting for covariates, increasing time between rupture and repair was associated with higher cost (P < .05). Surgical location, surgical approach, and repair suture were also associated with total cost (P < .05).
Conclusion:
Substantial variability in the cost of primary midsubstance Achilles rupture repair is driven by factors including timing of surgical repair, intraoperative surgeon-specific characteristics (ie, surgical approach and suture choice), and surgical location. Further standardization of treatment approach and decreasing time to the operating room could lower cost variability and improve the value of care for patients with midsubstance Achilles tendon rupture undergoing surgery.
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NewsBot · Jul 13, 2025 at 6:25 AM

Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis
Zhitao Yang et al
J Orthop Surg Res. 2025 Jul 8;20:626. doi: 10.1186/s13018-025-05990-y

Background
Acute Achilles tendon rupture (AATR) is one of the most common sports injuries, however, the optimal treatment remains controversial. The purpose of this study was to compare the effectiveness of surgical and conservative treatment on clinical outcomes.

Methods
The PubMed, Web of Science, Embase, and Cochrane Library databases were searched to identify relevant studies published from database inception up to April 2025. Two reviewers independently screened titles and abstracts using specified criteria. Included studies compared differences between surgical and conservative treatment in terms of re-rupture rate, incidence of other complications, rate of return to sports, and Achilles Tendon Total Rupture Score (ATRS), and to examine the effect of platelet-rich plasma (PRP) on clinical outcomes. Dichotomous outcomes are expressed as odds ratio (OR), and continuous data are expressed as mean difference (MD) with corresponding 95% confidence interval (CI). Heterogeneity was assessed using the I2 statistic, A fixed effects model was used when I2 ≤ 50%; otherwise, the random effects model was used. Statistical analysis was performed using Review Manager version 5.4.1.

Results
Thirty-three studies comprising 35896 patients were included. Compared with the nonoperative group, the operation group exhibited lower re-rupture rates (risk ratio [RR] 0.44 [95% confidence interval (CI), 0.34–0.57], P < .00001), a higher rates of return to sport (RR 1.32 [95% CI, 1.03–1.69], P = .03), higher infection rates (RR 2.54 [95% CI, 1.62–3.98], P < .0001), including deep infection (RR 1.91 [95% CI, 1.15–3.16], P = .01) and superficial infection (RR 4.89 [95% CI, 1.57–15.24], P = .006) and higher nerve injury rates (RR 3.67 [95% CI, 1.34–10.06], P = .01). Surgery reduced re-rupture rates by 3.52%, increased the rates of return to sport by 14.44%, conservative treatment reduced the nerve injury rates by 3.33%, and the infection rates by 0.53%. There was no statistical difference between the 2 treatments in the incidence of other complications, such as deep venous thrombosis (RR 0.93 [95% CI, 0.77–1.12], P = .43) and pulmonary embolism (RR 1.63 [95% CI, 0.49–5.48], P = .43), nor effect on ATRS (mean difference [MD] 7.02 [95% CI, -1.35–15.38], P = .10). Regardless of surgical or conservative treatment, there was no difference in the effects of PRP on the re-rupture rate, rate of return to sports, ATRS, and ankle range of motion.

Conclusion
Surgical treatment significantly reduced the risk for re-rupture and increased the rate of return to sports compared with conservative treatment; however, the incidence of complications, including nerve injury and infection, was lower with conservative treatment. Regardless of surgical or conservative treatment, PRP did not yield superior clinical or functional outcomes.
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NewsBot · Jul 13, 2025 at 10:18 PM

Open surgery and minimally invasive repair of acute Achilles tendon rupture: stratified outcomes based on immobilization duration in a prospective cohort study
Yuan Cao et al
J Orthop Surg Res. 2025 Jul 12;20(1):647.

Background: Acute Achilles tendon rupture (AATR) surgical repair debates center on the clinical efficacy of minimally invasive surgery (MIS) versus open surgery (OS), with immobilization duration poorly stratified. This prospective cohort study aimed to compare clinical outcomes of OS and MIS for AATR repair and evaluate the impact of immobilization duration (0, 2, or 4 weeks) on postoperative rehabilitation.

Methods: A total of 474 patients undergoing surgical repair for acute AATR were stratified into six groups based on surgical approach (OS: 265 cases; MIS: 209 cases) and immobilization duration (0, 2, or 4 weeks). The primary outcomes were postoperative complications, while secondary outcomes included recovery times for Achilles tendon function. Data regarding the operative times, incision lengths, the visual analog scale (VAS) score, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score, and the relative Achilles tendon resting angle (ATRA) were also collected.

Results: MIS groups demonstrated significantly shorter operative times (34.1-34.4 vs. 45.1-46.1 min, P < 0.001) and reduced incision lengths (2.2-2.4 vs. 4.5-4.7 cm, P < 0.001) compared to OS. Postoperative VAS scores were markedly lower in MIS cohorts during the first 2 weeks (P < 0.001), with pain resolution comparable across all groups by 8 weeks. Despite the superior early functional recovery in PF (9.1-33.4 vs. 14.6-38.9 days, P < 0.001), Group D and E exhibited higher re-injury rates compared to OS (P < 0.05), in which Group D also demonstrated higher re-operation rates (5.6% vs. 0, P = 0.038). Prolonged immobilization (4 weeks) delayed functional recovery in both cohorts (P < 0.001). While transient differences in AOFAS Ankle-Hindfoot Scale and ATRS scores were observed at intermediate time points, all groups achieved near-maximal functional scores by 48 weeks, with no significant between-group differences (P > 0.05). Relative ATRA exhibited no significant intergroup differences at 48 weeks postoperatively (P > 0.05).

Conclusion: MIS for acute Achilles tendon rupture achieves faster early recovery but carries higher re-injury risks, mitigated by 4-week immobilization. OS benefits from shorter (2-week) immobilization. Both approaches yield equivalent long-term functions, emphasizing the need for tailored protocols and refined MIS techniques to optimize outcomes.
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NewsBot · Jul 15, 2025 at 2:46 AM

A New Surgical Technique for Achilles Tendon Rupture: A Retrospective Study of 18 Cases
Dawei Xin, Zhuosong Mu, Linru Zeng, Gan Luo & Yafeng Mo
Indian Journal of Orthopaedics

Background
The optimal treatment for acute closed Achilles tendon rupture (ATR) is still controversial. Many grassroots hospitals lack advanced equipment to perform effective minimally invasive surgeries, and open surgeries increase the incidence of complications. Therefore, we have developed a new technique specifically for grassroots hospitals. It involves using oval forceps-assisted minimally invasive suture bridge technology to treat acute closed Achilles tendon ruptures. This technique is easy to perform and has shown good clinical outcomes.

Methods
We reviewed the therapeutic effectiveness of using oval forceps-assisted minimally invasive suture bridge technique in the treatment of 18 patients with ATR. All patients were followed up for a minimum of 12 months. Preoperative and postoperative follow-up data were reviewed to analyze the results and evaluate the surgical outcomes.

Results
The patients were followed up for 12–16 months [(
) months]. There was no statistically significant difference in the ankle joint visual analog scale (VAS) scores at 3, 6, and 12 months postoperatively (
0.05). However, there was a statistically significant increase in ankle joint active range of motion(AROM) at 3, 6, and 12 months postoperatively (
0.05). At the same time, there was no statistically significant difference in AROM between the healthy side and the affected side at 12 months postoperatively. The American Orthopaedic Foot & Ankle Society(AOFAS) scores and Achilles Tendon Total Rupture Score (ATRS) showed a gradual improvement at 3, 6, and 12 months postoperatively, with statistical significance (
0.05). All surgical incisions healed well without complications such as injury to the sural nerve or incision infection. Three patients experienced pain at the site of ATR at 3 months postoperatively, which resolved after a 2-week course of oral nonsteroidal anti-inflammatory drugs (NSAIDs). One patient experienced transient pain at the Achilles tendon insertion point after 6 months of activity, which disappeared after a 2-week course of oral NSAIDs.

Conclusion
The use of oval forceps-assisted suture bridge technique for the treatment of acute closed ATR is characterized by its small incision, simple operation, and minimal complications, meeting the requirements for early functional rehabilitation of patients. For grassroots hospitals that receive a large number of patients, the oval forceps-assisted suture bridge technique is a surgical method worth popularizing.
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