Giant cell tumor of the patellar tendon sheath in childhood: case report.

The aim of this study was to report a rare case of a giant cell tumor of the patellar tendon sheath. This indicates the diagnostic procedures and treatment options for giant cell tumors of the patellar tendon. This study reported a case of a 13-year-old male patient with a giant cell tumor of the tendon sheath. In our case, open arthrotomy was performed with complete surgical excision of the lesion. Histopathological examination revealed a giant cell tumor. At the last follow-up, 2 years after surgery, no complications were reported. The giant cell tumor of the patellar tendon sheath is an uncommon benign tumor. It mimics common knee symptoms. A differential diagnosis is definitely a challenge. Available operation approaches have demonstrated similar results, which lead to symptom relief and a low recurrence rate.

Comparison of various treatment modalities for the management of bone marrow edema syndrome/transient osteoporosis in men and non-pregnant women: a systematic review.

Transient osteoporosis (TO) or bone marrow edema syndrome (BMES) is a self-limited clinical condition, which affects middle-aged men and women. It can be treated with miscellaneous conservative and surgical measures, which are analyzed in this systematic review. INTRODUCTION: BMES/TO is a transient clinical entity, which can be treated with various therapeutic modalities. The aim of our study was to assess the efficacy of different therapeutic options for the alleviation of pain and reduction of bone marrow edema (BME) in patients with BMES/TO, as well as to propose a therapeutic algorithm. METHODS: PubMed, Scopus, Cochrane, and Google Scholar were searched. Eligibility and extraction of studies were conducted by two authors. Methodological quality assessment was carried out with the modified Delphi technique, Methodological Index for Non-Randomized Studies (MINORS) criteria, and Cochrane Collaboration's risk of bias tool. Outcomes that were compared were time of pain resolution, VAS pain scores, and BME regression on magnetic resonance imaging (MRI). RESULTS: A total of 36 articles (880 patients) were included. Bisphosphonates had higher efficiency in less than 1-month outcomes on pain resolution compared with core decompression (CD), while iloprost was more efficient at 1-3 months compared with bisphosphonates and CD. At 3-6 months, all three of the aforementioned showed equal results on pain resolution, and at a period of 6-12 months, CD and extracorporeal shockwave therapy (ESWT) showed excellent results followed by bisphosphonates and the conservative group (CG) consisting of non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or restricted weight bearing. On MRI at 1-3 months, bisphosphonates, iloprost, and CD had relatively the same outcomes on BME resolution, with the least promising being the CG. At 3-6 months, CD seemed to have achieved the best results on the resolution of BME, followed by ESWT, CG, and bisphosphonates group. At 6-12 months, ESWT had the best outcomes compared with the conservative, bisphosphonates, and iloprost groups. CONCLUSION: BMES/TO has been treated with many non-standardized measures due to the low number of highly reliable studies. Current literature shows promising results with regard to the reduction of the clinical course of BMES/TO, but further large multicenter randomized controlled trials, as well as standardized radiological and clinical scores, are warranted to acquire evidence-based recommendations on the therapeutic algorithm.

Local Antibiotic Delivery Systems in the Surgical Treatment of Diabetic Foot Osteomyelitis: Again, No Benefit?

This retrospective study aimed to compare the outcomes and healing parameters of 3 groups of surgical treatment combined with and without local antibiotic administration in diabetic foot osteomyelitis (DFO). Overall, 25 patients with DFO who met the criteria were included in the study. Surgical debridement was used with systemic antibiotic administration alone (group A; n = 8) or combined with local application of antibiotic-loaded polymethylmethacrylate beads (group B; n = 9) or antibiotic-loaded hydroxyapatite and calcium sulfate beads (group C; n = 8). In total, 87.5% patients in group A, 100% in group B, and 87.5% in group C healed (P = .543). Median time to healing was 17 weeks in group A, 18 weeks in group B, and 19 weeks in group C (P = .094). One patient (12.5%) in group A was amputated. DFO recurrence rate was 12.5% in group A and 12.5% in group C (P = .543). Median hospitalization was 9 days in group A, 8 days in group B, and 9 days in group C (P = .081). In conclusion, adjunctive local antibiotic therapy was not shown to improve outcomes in surgically treated DFO.

Reverse Shoulder Arthroplasty, Deltopectoral Approach vs. Anterosuperior Approach: An Overview of the Literature.

Reverse shoulder arthroplasty (RSA) has become an optimal treatment for numerous orthopedic entities, such as rotator cuff tear arthropathies, pseudoparalysis, fracture sequelae, acute fractures, failed arthroplasties, osteoarthritis, and rheumatoid arthritis, and is linked with relief of topical pain and regaining of functionality. Presently, RSA has been conducted through anterosuperior (AS) or deltopectoral (DP) approach. The aim of the study was to discuss both approaches and to examine broadly their features to render a comparison in terms of clinical effectiveness. An electronic search in PubMed, EMBASE, and Google Scholar databases was performed, using combinations of the following keywords: RSA, DP approach, AS approach, notching, and cuff tear arthropathy. A total of 61 studies were found, and 16 relevant articles were eventually included. Currently published literature has not shown significant diversities in the clinical course due to approach preference; risk of instability seems to be greater in DP approach, while regarding scapular notching and fracture rates the findings were conflicted. In addition, the AS approach has been associated with decreased risk of acromial and scapular spine fractures. In conclusion, both surgical approaches have shown similar clinical outcomes and effectiveness concerning pain and restoring range of motion (ROM) in rotator cuff tear arthropathies. In the future, further investigations based on large-scale well-designed studies are required to address clinical gaps allowing in-depth comparison of both approaches.

Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis: A Brief Review.

Diabetic foot osteomyelitis (DFO) is a severe, difficult to treat infection. Local antibiotic delivery has been studied as a potential therapeutic adjunct following surgery for DFO. This review aims to summarize the evidence on local antibiotic delivery systems in DFO. PubMed database was searched up to March 2020. Overall, 16 studies were identified and included: 3 randomized controlled trials (RCTs), 3 retrospective studies (RSs), and 10 case series. In the RCTs, gentamicin-impregnated collagen sponges significantly improved clinical healing rates and slightly improved duration of hospitalization. In the RSs, antibiotic-impregnated calcium sulfate beads non-significantly improved all healing parameters, but did not reduce post-operative amputation rates or time of healing. The majority of case series used calcium sulfate beads, achieving adequate rates of healing and eradication of infection. In conclusion, evidence for add-on local antibiotic delivery in DFO is still limited; more data are needed to assess this therapeutic measure.

Giant Neurofibroma of the Left Median Nerve Associated With Damage of the Ipsilateral Distal Radius.

A 74-year-old Caucasian woman presented with a large mass on her left distal radius, which had previously caused a fracture of the bone at this site and the palmar site that was treated with external fixation a year ago. The patient did not mention tumor-related family history and other neoplasms before the fracture of the distal radius. She noticed that the gradually growing mass had appeared after the fracture treatment. A thorough evaluation of the lesion confirmed the diagnosis of a large benign neurofibroma with distal radius impairment. The diagnostic and therapeutic procedure included the complete excision of the tumor and a six-week cast immobilization of the radius. On the final follow-up two years postoperatively, her clinical situation was satisfactory with no signs of recurrence. Although rare, isolated benign neurofibromas of enormous sizes are associated with bone damage. In our view, immediate surgical excision is crucial and enables total recovery postoperatively.

Perioperative Blood Management Strategies for Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand on This Matter?

Total hip replacement (THR) has proved to be a reliable treatment for the end stage of hip osteoarthritis. It is a common orthopaedic procedure with excellent results, but is associated with significant blood loss and high rates of allogeneic blood transfusion (ABT). The potential complications and adverse events after ABT, combined with the ongoing research, have resulted in multimodel, multidisciplinary blood management strategies adoption, aiming to reduce the blood loss and transfusion rates. Many reviews and meta-analyses have tried to demonstrate the best blood management strategies. The purpose of this study is to review any evidence-based blood conserving technique, dividing them in three stages: preoperative, intraoperative and postoperative.

Supercapsular Percutaneously Assisted total hip arthroplasty versus lateral approach in Total Hip Replacement. A prospective comparative study.

BACKGROUND: Supercapsular Percutaneously Assisted total hip arthroplasty (SuperPATH approach) is a relatively new minimal invasive approach which has been associated with encouraging postoperative outcomes. The aim of this study is to compare the minimal invasive (MIS) SuperPATHapproach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data. MATERIAL AND METHODS: Forty eight (48) consecutive patients undergone primary total hip arthroplasty (THA) by the same surgeon (GD), were enrolled in our study. From this study population, the modified Hardinge approach was performed in 23 patients and the SuperPATH approach was performed in 25 patients. Soft tissue impairment was studied based on three representative markers, C-reactive-protein (CRP) and two enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH). We measured these markers 10 min after surgery, on 1st and 2nd postoperative day. The levels of the perceived pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS) score which was registered 6 h, 12 h, 1 day and 2 days postoperatively. The functional and clinical evaluation of the patients was achieved with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9) and neuropathic pain questionnaire (DN-4) 6 months and 1 year postoperatively. The rest of the collected data included patient's age, gender, body mass index (BMI), other comorbitities, the American Society of Anesthiologists score (ASA), Charlson Index score, the pre-operative diagnosis, implant positioning through radiographic evaluation, the type of anesthesia, the days of hospitalization, the operating time, incision length, blood loss and blood transfusion requirements and complication rates. RESULTS: SuperPATH approach was related with statistically considerable lower levels of CRP at 10 min (p = 0,001) and at 24 h (p = 0,047) postoperatively, as well as lower LDH levels in all time points postoperatively. It was also associated with shorter incision length (p < 0.001), longer operating time (p < 0.001), higher mean cup inclination p < 0.001, decreased postoperative pain levels the first 6 and 12 h (p < 0.001) and relatively better clinical and functional results 6 months after surgery, but not at 12 months. CONCLUSION: Our study revealed some advantages in favor of the SuperPATH approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is required in order to further elucidate its efficacy.

Total hip replacement using MINIMA® short stem: A short-term follow-up study.

BACKGROUND: Total hip replacement has become one of the most successful orthopaedic procedures. The length of the femoral stem constitutes one of the most important geometrical and mechanical features of the prosthesis. Several different implants are currently available but data are limited concerning the clinical results for some of these implants. AIM: To report the short-term clinical and radiological results of a novel squared section, tapered design - with four conicity - short stem in total hip replacement. METHODS: This is a retrospective study of a prospectively collected data using of MINIMA® short stem in 61 consecutive patients with at least 1 year follow-up. The collected data included patients' demographics, type of arthritis, bone morphology, perioperative data, clinical results using Harris Hip Score, EuroQol (EQ-5D), pain score and satisfaction rate, complications and radiological results. RESULTS: Total 61 patients were included in our study with a mean age of 56 years of age (range 25-73 years). The majority of them (68.6%) were women, thirty seven patients (56.9%) were less than 60 years of age and almost half of patients (45.1%) suffered from secondary osteoarthritis (hip dysplasia, osteonecrosis, etc.). The mean time of follow-up examination was 33.4 mo (2.8 years) with a range of 12-57 months (1-4.8 years). In 35 patients (56.9%) the follow-up examination was more than 3 years. No major complications such as revision, periprosthetic fracture, dislocation or infection were presented. Re-admission 90 d postoperatively or laterwas deemed unnecessary for any reason regarding the operation. Respectively, the mean pain score, mean Harris hip score, and mean EQ-5D were improved from 6.3, 58.7 and 77.3 preoperatively to 0.1, 95.1, and 79.8 postoperatively. The Satisfaction rate at the final follow-up was 9.9 (SD 0.3, range 8.0-10.0). All stems were classified as stable bone ingrowth and no radiolucent lineswere revealed in any of the modified Gruens' zone at the postoperative X-rays. Stem subsidence was within acceptable limits and the incidence of distal cortical hypertrophy was relatively low. CONCLUSION: The clinical and radiological results concerning the MINIMA® short stem are excellent according to this first report of this specific design of the short femoral stems. Because of the small number of cases and short-term follow-up of this study, a longer follow up time and more patients' enrollment is required.

The results of a stepwise implementation of a fast-track program in total hip and knee replacement patients.

BACKGROUND: Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department. MATERIAL AND METHODS: This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recorded (i.e. respectively Patients' demographics, ASA classification, Charlson index, LOS, blood loss, transfusion rate, complications and 30 - day readmissions). RESULTS: Four hundred and thirty four patients underwent either TKR (n: 302) or THR (n:132) and were included in this study. A gradual reduction of mean LOS was found in THR patients from 5.7 days to 3.0 days and in TKR patients from 5.6 days to 3.4 days. Furthermore, no significant difference was found in complications or regarding the 30-day readmission rate at the different stages of implementation of the different FT components (i.e. at the final stage 96.7% of THR and 86.7% of TKR patients were discharged to home by the fourth post-operative day). CONCLUSION: The stepwise implementation of a FT program in an unelected population of THR and TKR patients was effective and safe, reducing the post-surgical recovery time and patients' LOS with no major complications and no increase of 30-day re-admissions.

Gentamycin elution from polymethylmethacrylate and bone graft substitute: Comparison between commercially available and home-made preparations.

Polymethylmethacrylate (PMMA) represents the current gold standard as an antibiotic delivery carrier in orthopaedic surgery. Despite the accepted use of local antibiotic carriers, there aren't any conclusive data comparing PMMA to Bone Graft Substitutes. The aim of this in vitro study was to compare the elution profile of gentamicin from various preparations of PMMA cements and Herafill beads. All cements had high initial elution during the first hour which then slowly decreased, Herafill beads on the other hand showed its higher elution around the eighth hour. Herafill, in general, presented the highest elution of gentamicin regardless of its input amount.

The Effect of Strontium Ranelate on Fracture Healing: An Animal Study.

BACKGROUND: Strontium ranelate (StR) is an antiosteoporotic agent previously utilized for the enhancement of fracture union. We investigated the effects of StR on fracture healing using a rabbit model. METHODS: Forty adult female rabbits were included in the study and were divided in 2 equal groups, according to StR treatment or untreated controls. All animals were subjected to osteotomy of the ulna, while the contralateral ulna remained intact and served as a control for the biomechanical assessment of fracture healing. Animals in the study group received 600 mg/kg/day of StR orally. All animals received ordinary food. At 2 and 4 weeks, all animals were euthanatized and the osteotomy sites were evaluated for healing through radiological, biomechanical, and histopathological studies. RESULTS: The treatment group presented statistically significant higher callus diameter, total callus area, percentage of fibrous tissue (p < 0.001), vessels/mm2, number of total vessels, and lower osteoclast number/mm2 (p < 0.05) than the control group at 2 weeks. Additionally, the treatment group presented significantly higher percentages of new trabecular bone, vessels/mm2, osteoclast number/mm2, and lower values for callus diameter, as well as total callus area (p < 0.05), than the control group at 4 weeks. At 4 weeks, in the treatment group, force applied (p = 0.003), energy at failure (p = 0.004), and load at failure (p = 0.003) were all significantly higher in the forearm specimens with the osteotomized ulnae compared to those without. Radiological bone union was demonstrated for animals receiving StR at 4 weeks compared with controls (p = 0.045). CONCLUSION: StR appears to enhance fracture healing but further studies are warranted in order to better elucidate the mechanisms and benefits of StR treatment.

Surgical modalities for the management of bone marrow edema of the knee joint.

BACKGROUND: Bone marrow edema (BME) is a radiological term which can be found in many conditions with varied pathogenesis and histopathological images. It usually presents with pain in the affected joint and is diagnosed with MRI. Subchondroplasty (SCP) and core decompression (CD) are the surgical methods that are available to achieve pain relief and functional improvement. Both surgical methods have their own indications and are used depending on the patient's history. The aim of this literature review article is to discuss the surgical modalities for the management of bone marrow edema focusing on the knee joint. Such topic which analyzes both surgical methods for treatment of bone marrow edema of the knee joint has never been described in a review article before. MATERIALS AND METHODS: For the purpose of our manuscript we thoroughly searched electronic databases such as Pubmed and Medline to acquire the appropriate material for our review paper. Only English articles were used in this review. In our study we included every article that had described the surgical management of BME of the knee by CD and SCP. In the discussion we included 18 studies (9 CD and 9 SCP) with a total number of patients equal to 397, while 206/397 had undergone surgical intervention (169 underwent SCP and 37 CD). RESULTS: Follow-up of 180 patients out of 206 were available for our review. A total number of 166 patients (92.2%) were successfully treated. Specifically, 29 (100%) patients were treated by CD and 137 (90.7%) by SCP. In a study, 10 patients who underwent SCP for BME secondary to advanced osteoarthritis (OA) yielded poor results. In other studies, pain persistency was observed in 2 patients, 1 patient had postoperative infection and another patient eventually underwent total knee arthroplasty (TKA). 70% prevention of TKA was achieved by SCP in a study of 66 patients with BME secondary to advanced OA. Thus, a total number of 166 patients were considered as clinical success and 14 patients as clinical failure. CONCLUSIONS: The included studies that have been published referred to the surgical methods of CD or SCP for the management of BME of the knee but none of that summarizes all current studies on both methods. Those studies seem that CD is a surgical technique that is proposed to perform in patients without findings of OA that usually fail to respond to conservative treatment. On the other hand, the option of SCP technique is carried out in patients with varied stage of OA associated with subchondral BME. Both methods aim to reduce the pain and to improve function in the setting of subchondral BME. Nevertheless it is not clear in literature which method is the best according to the criteria of the use. This literature review shows a lack of standardized guidelines with respect to diagnosis and surgical treatment.

Ulnar nerve entrapment in Guyon's canal caused by a ganglion cyst: two case reports and review of the literature.

In this article, two cases of ulnar nerve neuropathy in Guyon's canal caused by a ganglion cyst are reported. A review of the literature found 73 cases reported in 35 articles of ulnar neuropathy at the wrist secondary to a ganglion cyst. We investigated the pathogenesis of ganglion cysts, which are separated as extraneural and intraneural. At this anatomical area, there are a variety of clinical factors that can also lead to ulnar nerve compression such us trauma, fracture of the hamate's hook, arterial thrombosis, tumors and other anatomical variations. The symptoms may include weakness, paresthesia, numbness and atrophy of hypothenar muscles. Except the careful clinical assessment, magnetic resonance imaging, ultrasound and electrophysiological control are useful tools regarding our differential diagnosis. The treatment of this clinical condition is surgical. We consider that instant surgical decompression is of the essence and enables postoperatively total recovery. LEVEL OF EVIDENCE: Level III.

Correction to: Ulnar nerve entrapment in Guyon's canal caused by a ganglion cyst: two case reports and review of the literature.

The original version of this article unfortunately contained a mistake. Table 1 footnotes were missing.

Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study.

BACKGROUND: Tranexamic acid (TXA) is widely used in the orthopedic field and particularly in total knee arthroplasty (TKA). Its efficacy and safety in reducing the blood loss in TKA have been well-documented in the current literature. Little data regarding TKA without tourniquet and TXA exist. Our aim is to compare three different dosages of intravenous (IV) TXA in TKA without tourniquet. MATERIALS AND METHODS: A total of 180 patients undergoing TKA for knee osteoarthritis were stratified in three equal groups. All surgeries were performed under spinal anesthesia, without tourniquet. Group A (60 patients) received 15 mg/kg of IV TXA given on induction, Group B (60 patients) received an additional dose of IV TXA (15 mg/kg) 3 h after incision and Group C (60 patients) received an additional (third) dose 3 h later (15 mg/kg). The measured outcomes were the change in hemoglobin (Hb) from pre-operatively to post-operatively, the amount of blood transfusion given (units), the functional and quality of life (QoL) and pain assessment based on their corresponding scoring system. RESULTS: Calculated blood loss, Hb decrease and transfusion rate were significantly lower in Group C (p value < 0.05). Additionally, patients that had been included in the three-dosage group benefited much more in terms of faster rehabilitation, better QoL, decreased post-operative pain, with no increase in complications. CONCLUSION: According to our results, three doses of IV TXA have effectively and safely reduced blood loss and the need of allogeneic blood transfusion in patients undergoing TKA without tourniquet, with additional patients-related benefits. LEVEL OF EVIDENCE: II.

The use of tourniquet may influence the cement mantle thickness under the tibial implant during total knee arthroplasty.

INTRODUCTION: It is still unknown whether the creation of blood-free surfaces by the use of tourniquet during total knee arthroplasty (TKA) has an influence on cement penetration and on implant fixation. The aim of this study is to evaluate the cement mantle under tibial component and the occurrence of progressive radiolucent lines (RLLs) according to the use of tourniquet in primary TKA. MATERIALS AND METHODS: Fifty patients undergone TKA without the use of tourniquet (group 1) were well matched regarding baseline characteristics with 50 TKAs with the use of tourniquet (group 2). Patients were followed up prospectively. Cement mantle thickness was measured using immediate postoperative X-rays, and the occurrence of progressive radiolucency was finally evaluated in 3-year follow-up. New Knee Society Score (KSS) was used to compare clinical outcome between groups. RESULTS: Mean cement mantle thickness was 9.27 ± 1.86 mm in group 1 versus 10.49 ± 2.31 mm in group 2 (p = 0.005). Mean cumulated width of RLLs in anterioposterior (AP) view was 7.74 ± 6.68 mm in group 1 versus 3.48 ± 4.69 mm in group 2 (p < 0.001). The percentage of RLLs in AP view was related to the cumulated cement mantle thickness in the same view (r = - 0.218, p < 0.05). There was no significant difference between groups at the final follow-up in terms of ROM and new KSS. CONCLUSION: Our results suggest that the use of tourniquet increased the cement mantle thickness under tibial implant and had an influence on the occurrence of RLLs in cement-bone interface, which is related to implant survivorship, with this implant design.

Short stems in total hip replacement: evidence on primary stability according to the stem type.

BACKGROUND:: As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently - mechanical and clinical studies - concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis. METHOD:: We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems - as expressed by implant micromotion and stem subsidence - according to our previously proposed short-stem classification. RESULTS:: Mechanical in vitro studies on stem micromotion are very few and limited to type 2 "partial collum" short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems. CONCLUSION:: There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.

Validation and cross-cultural adaptation of Greek version of Achilles tendon Total Rupture Score.

BACKGROUND: The purpose of this study was the translation, cross-cultural adaptation and validation of the Achilles Tendon Total Rupture Score (ATRS) in Greek population. METHODS: The translation and cross-cultural adaptation of the original version of ATRS in Greek language was performed according to the methodology described by Beaton et al. Validation and test-retest reliability were evaluated in forty-six patients, treated surgically for acute Achilles tendon rupture. Validity was evaluated by correlation of total and all subscale scores of Greek version of Manchester Foot Pain and Disability Index (MFPDI). Test-retest reliability evaluated with interclass correlation coefficient and Crombach's α coefficient was used for internal consistency. RESULTS: The internal consistency (α=0.96) and test-retest reliability (ICC=0.97) were excellent. There were no ceiling and floor effects during test-retest assessment. The Greek version of ATRS showed strong correlation with all subscales and overall score of MFPDI (pain subscale: R=-0.954, p<0.01, function subscale: R=-0.811, p<0.01, appearance subscale: R=-0.763, p<0.01, overall: R=-0.914, p<0.01). CONCLUSIONS: Greek version of ATRS was successfully adapted in Greek population and it appears to be a valid and reliable instrument to evaluate outcomes in Greek speaking patients after Achilles tendon rupture. LEVEL OF EVIDENCE: Level III.