[Acute Achilles tendon rupture; intend to treat conservatively]. / Acute achillespeesruptuur.

Recent research shows that the functional outcome after an acute Achilles tendon rupture is comparable after conservative versus operative treatment. It is therefore recommended to treat patients conservatively, but strong reasons for surgical treatment exist. In principle, no additional radiographic diagnostic exams are indicated for the diagnosis. An appropriate anamnesis, palpable gap and positive Thompson test have an excellent sensitivity. In case of doubt, an ultrasound should be performed as the first step. A shared decision process should be pursued for establishing treatment plan. However, it is recommended that patients be treated conservatively unless strong arguments for surgical intervention are present. It is important to properly inform patients, and thus manage expectations about the expected rehabilitation process. If there is an increased risk of re-rupture, such as in athletes or during physically demanding work, surgical treatment can be considered. Then a surgical technique in which expertise and experience has been gained should be used as no difference in outcome have been found after open versus minimal invasive techniques.

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

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

Treatment outcome of chronic patellar tendon rupture using autogenous semitendinosus graft: a retrospective case series.

PURPOSE: This study highlights the pattern of presentation, treatment, early functional outcome, and complications observed in the management of chronic patellar tendon ruptures using our preferred technique of autogenous semitendinosus graft reconstruction. METHODS: This was a retrospective case series involving consecutive patients who underwent patellar tendon reconstruction and met the inclusion criteria. The outcome measures were determined by the post-operative knee range of motion (R.O.M), the post-operative International Knee Documentation Committee (IKDC) score, and pattern of post-operative complications. RESULTS: Nine patients were included in this case series. The mean age of the patients was 35.4 ± 6.8 years (range 27-44 years). Trauma to the knee accounted for majority of the cases (62.5%). Six (66.7%) of the nine patients suffered a patellar tendon rupture from contact injury during sporting activities. The mean length of time from injury to presentation was 20.5 ± 11.2 weeks (range 6-69.5 weeks). Normal knee function in a case (11.1%), nearly normal knee function in 7 cases (77.8%), and abnormal knee function in a case (11.1%) were recorded as a measure of outcome of surgery. The mean post-operative IKDC score was 70.0 ± 6.1 (range 55-77), which was higher than the mean pre-operative score of 26.4 ± 5.1 (range 18-32). The post-operative knee R.O.M averaged 97.2 ± 16.2° (range 70-120°) with a single case with a 10° extension lag noted. CONCLUSION: Normal to near-normal knee function was obtained with the treatment of chronic patellar tendon rupture in the majority of cases using autogenous semitendinosus graft for patellar tendon reconstruction in our series.

Flexor Tendon Injuries.

Flexor tendon injuries are complex, and management of these injuries requires consideration of the surgical timing, injury location, approach, and soft tissue handling. Complications are common, including adhesions, tendon rupture, infection, and a high reoperation rate for zone 2 repairs. Special considerations are given to chronic ruptures, concomitant fractures, and pediatric cases. We discuss current concepts that may improve patient outcomes.

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

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

Rupture of intrahepatic bile duct after ERCP for common bile duct stone: A case report of rare complications.

RATIONALE: Complications after endoscopic retrograde cholangiopancreatography (ERCP) are diverse and usually treated with nonoperative management or percutaneous drainage; however, there are still some rare, life-threatening complications. This is an extremely rare case of biliary peritonitis caused by rupture of the intrahepatic bile duct after ERCP. PATIENT CONCERNS: A 63-year-old male underwent ERCP for common bile duct stones. On the second day after the procedure, the patient developed sepsis and abdominal distention. Contrast-enhanced computed tomography revealed a subcapsular hepatic fluid collection attached to the bile duct of segment VII. DIAGNOSES: Sepsis resulted in liver parenchyma rupture and intrahepatic bile duct injury after ERCP. Intraoperative cholangiography revealed a connection between a hole in the liver parenchymal surface and the intrahepatic bile duct. INTERVENTIONS: Surgeons performed the cholecystectomy, inserted a T-tube into the common bile duct stones, sutured the defect, and put 2 drainage tubes around the lesion. OUTCOMES: Postoperative recovery was uneventful, and the patient was discharged on the 17th postoperative day. LESSONS: Intrahepatic bile duct perforation after ERCP can lead to rupture of the liver parenchyma, biloma, or abdominal peritonitis. Multidisciplinary management is necessary to achieve favorable outcomes.

A stacked autoencoder-based aid system for severity degree classification of knee ligament rupture.

BACKGROUND: Knee ligament rupture is one of the most common injuries, but the diagnosis of its severity tends to require the use of complex methods and analyses that are not always available to patients. AIM: The objective of this research is the investigation and development of a diagnostic aid system to analyze and determine patterns that characterize the presence of the injury and its degree of severity. METHODS: Implement a novel proposal of a framework based on stacked auto-encoder (SAE) for ground reaction force (GRF) signals analysis, coming from the GaitRec database. Analysis of the raw data is used to determine the main features that allow us to diagnose the presence of a knee ligament rupture and classify its severity as high, mid or mild. RESULTS: The process is divided into two stages to determine the presence of the lesion and, if necessary, evaluate variations in features to classify the degree of severity as high, mid, and mild. The framework presents an accuracy of 87 % and a F1-Score of 90 % for detecting ligament rupture and an accuracy of 86.5 % and a F1-Score of 87 % for classifying severity. CONCLUSION: This new methodology aims to demonstrate the potential of SAE in physiotherapy applications as an evaluation and diagnostic tool, identifying irregularities associated with ligament rupture and its degree of severity, thus providing updated information to the specialist during the rehabilitation process.

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

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

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

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

Treatments for pathogen infection rescued 2 patients with renal artery rupture after kidney transplantation: A case report.

RATIONALE: Renal artery rupture due to allograft infection, especially by fungi, is a serious clinical complication that can occur after kidney transplantation, and may lead to graft loss and death. PATIENT CONCERNS: Two kidney recipients from China who developed renal artery rupture at our hospital on 5 days (47-year-old female) and 45 days (39-year-old male) after surgery. DIAGNOSES: The male had immunoglobulin A nephropathy as a primary disease, and experienced a postoperative attack of vascular rejection and mixed infection by Mucor and bacteria. The female had chronic glomerulonephritis as a primary disease, and experienced renal artery rupture near the anastomosis site with infection by fungi and other pathogens. INTERVENTIONS: The male received resection of the implanted kidney and antibiotic therapy with intravenous vancomycin (0.5 g, 2 days) and amphotericin B (530 mg in 33 days). The female received replacing the segment of renal arterial and internal iliac artery by saphenous vein, as well as antibiotic therapy with amphotericin B (320 mg in 8 days). OUTCOMES: The male was recovered and received a second transplantation, while the female was discharged on postoperative day 19. LESSONS: In both patients, prompt surgery and aggressive treatment with an antifungal drug (amphotericin B) and antidrugs led to successful rescue.

[Traumatic gallbladder rupture in a 9-year-old child]. / Travmaticheskii razryv zhelchnogo puzyrya pri sochetannoi travme u rebenka 9 let.

We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.

Achilles Tendon Stiffness: Influence of Measurement Methodology.

OBJECTIVE: Mechanical stiffness derived from force-elongation curves is fundamentally different from shear wave (SW) elastography-based tissue properties. We compared these techniques, with a total of five methods of assessing Achilles tendon (AT) stiffness. METHODS: Seventeen participants (12 male and 5 female) with unilateral AT rupture performed submaximal contractions at 30% and 10% maximal isometric contraction torque of the un-injured limb. SW velocity was acquired at rest. Force-elongation curves were assessed from the free AT and the medial gastrocnemius (MG) tendon. Mechanical stiffness was determined near the end of the linear region of the force-elongation curve and from the toe region. Bivariate correlations between mechanical stiffness and SW velocity, as well as pairwise t-tests between limbs, were computed. RESULTS: In the injured limb, SW velocity correlated with MG tendon and free AT toe-region stiffness during 10% (r = 0.59, p = 0.020 and r = 0.60, p = 0.011, respectively) and 30% of submaximal contractions (r = 0.56, p = 0.018 and r = 0.67, p = 0.004, respectively). The un-injured limb showed no associations. In both limbs pooled together, SW velocity correlated with MG tendon toe-region stiffness in 30% of submaximal contractions (r = 0.43, p = 0.012). Free tendon mechanical stiffness was lower in the injured limb, with a mean difference of 148.5 Nmm⁻¹ (95% CI: 35.6-261.3, p = 0.013), while SW velocity was higher in the injured limb (1.67 m × s⁻¹, 95% CI; -2.4 to -0.9, p < 0.001). CONCLUSION: SW elastography may reflect AT viscoelastic properties at the initial slope of the force-length curve with strains <1% but cannot offer insight into AT mechanics at higher loads. Extended toe regions in the injured limb could have caused the association between mechanical stiffness and SW-based stiffness.

A Case of a Pediatric Finger Tendon Rupture Diagnosed by Point-of-Care Ultrasound.

BACKGROUND: Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging due to the difficulty in sensorimotor assessment in pediatric patients. Point-of-care ultrasound (POCUS) has currently been used for identifying tendon injury in adult acute care, but reports of its use in pediatric emergency departments are scarce. CASE REPORT: A previously healthy 14-year-old male patient visited our emergency department due to a finger laceration that occurred when he was cutting sausages using a knife. Physical examination revealed a 1.5 cm laceration over the palmer surface of the left fifth proximal phalanx. Tendon exposure was unremarkable, and the peripheral perfusion and sensation of the injured finger were intact. Flexion of the proximal and distal interphalangeal joints was limited due to pain. POCUS showed the disruption of the tendon structure over the laceration site, suggesting the flexor tendon rupture. Wound exploration by the orthopedic team revealed a transected flexor digitorum superficialis and flexor digitorum profundus and a tendon repair was performed. The patient was discharged with immobilization of the injured hand. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging to diagnose due to the difficulty in sensorimotor assessment in pediatric patients. POCUS can directly visualize a tendon structure without procedural sedation or radiation exposure, empowering physicians to diagnose tendon injuries and optimize patient care.

[The clinical treatment of laryngotracheal rupture injury].

Objective:To investigate the therapeutic effect of laryngotracheal rupture injury and management of related complications. Methods:A retrospective analysis was conducted on 10 patients with laryngotracheal rupture injury caused by trauma, admitted between October 2014 and October 2022. Results:Anti-shock treatment, local debridement, tracheal-cricoid cartilage or tracheal-tracheal anastomosis, laryngeal cartilage reduction and fixation, local transposition flaps repair and phase-Ⅱ airway reconstruction were performed respectively on 10 patients. Nine patients underwent operations of tracheal-cricoid cartilage or tracheal-tracheal anastomosis, with five of these were performed by cartilage broken reduction and fixation, placed with intraluminal stents of iodoform gauze fingerstalls for （8.2±1.6） days. Tracheal reconstruction surgery was performed on 2 cases during phase-Ⅱ and both were placed with T-shaped silicone tube to support for 3 months. Two cases required tracheoesophageal fistula surgical repair, and vocal cord suturing was conducted for three vocal fold injuries. Anti-shock treatment was given to one emergency case and closed thoracic drainage treatment was given to another one. We removed the tracheal cannula from 10 patients after surgery and one case was diagnosed with Ⅰ-level swallowing function of sub-water test. All cases recovered to take food per-orally. Conclusion:Maintenance of circulation and respiration functions is the major target during early treatment of laryngotracheal rupture. It should strive to complete the reconstruction of airway structure on phase-Ⅰ, among which end-to-end anastomosis to reconstruct airway and broken laryngeal cartilage reduction and fixation are the vital methods for airway structure reconstruction to achieve good results. It is suggested that the reconstruction of trachea and esophagus structures should be performed simultaneously to patients with tracheoesophageal fistula.

Regional variations in incidence and treatment trends of Achilles tendon ruptures in Finland: a nationwide study.

BACKGROUND AND PURPOSE: The aim of our study was to assess the regional variations in Achilles tendon rupture incidence and treatment methods in Finland during the period 1997-2019. METHODS: The Finnish National Hospital Discharge Register (NHDR) and the Finnish Register of Primary Health Care Visits (PHCR) were searched to identify all adult patients diagnosed with Achilles tendon rupture during our study period. The population-based annual incidence and incidences of surgically and non-surgically treated Achilles tendon ruptures were calculated for each hospital district. RESULTS: Achilles tendon rupture incidence increased from 17.3 per 105 person-years in 1997 to 32.3 per 105 in 2019. The mean incidence of Achilles tendon ruptures ranged from 26.4 per 105 (North Savo) to 37.2 per 105 (Central Ostrobothnia). The incidence of Achilles tendon ruptures increased in all areas. The proportion of non-surgical treatment of Achilles tendon ruptures ranged in 1997 from 7% (Vaasa) to 67% (Åland) and in 2019 from 73% (Southwest Finland) to 100% (East Savo, Kainuu, Länsi-Pohja, Åland). During the study period, a shift towards non-surgical treatment was evident in all hospital districts. CONCLUSION: Regional variations in Achilles tendon rupture incidence exist in Finland; however, the incidence increased in all areas during the follow-up period. More Achilles tendon rupture patients are currently being treated non-surgically throughout the country.

[Posterior cruciate ligament rupture : state of the art]. / Rupture du ligament croisé postérieur : état de l'art.

Posterior cruciate ligament (PCL) ruptures can cause severe knee instability and disability and thus, appropriate management is crucial for the successful restoration of patients' knee function. Rupture of the PCL can occur during sporting activity but more often, as a part of high-energy trauma. The diagnosis can be made using various clinical tests, such as the posterior drawer test or the quadriceps active test. MRI is the gold standard in imaging. PCL injuries can be classified from grade I to grade III, with increasing severity. Treatment can be conservative or surgical and should be personalized based on patients' demographic characteristics, grade of injury, level of instability, associated injuries and activity levels.

Les ruptures du ligament croisé postérieur (LCP) peuvent causer une instabilité sévère du genou et une incapacité importante, rendant ainsi une prise en charge appropriée cruciale pour le rétablissement d'une bonne fonction du genou. La rupture du LCP peut survenir lors d'une activité sportive, mais plus souvent, dans le cadre d'un traumatisme à haute énergie. Le diagnostic peut être posé à l'aide de différents tests cliniques, tels que le test du tiroir postérieur ou le test actif du quadriceps. L'IRM est l'examen de référence en imagerie. Les lésions du LCP peuvent être classées de grade I à III, avec une gravité croissante. Le traitement peut être conservateur ou chirurgical et doit être personnalisé en fonction des caractéristiques démographiques des patients, du grade de la lésion, du niveau d'instabilité, des lésions associées et des niveaux d'activité.

Subclavian arterial rupture due to blunt trauma injury: A case report.

RATIONALE: Subclavian arterial injury due to blunt trauma is rare but can have devastating outcomes. Massive hemorrhage or limb ischemia might develop depending on the extent of damage, and open repair might be necessary to salvage the limb. However, life-saving treatments should be prioritized in critically unstable patients. PATIENT CONCERNS: A 21-year-old male patient who was transferred to our trauma center following a motorcycle accident. Abdominal and chest computed tomography (CT) revealed right renal injury and massive hemothorax with several rib fractures in the right chest. DIAGNOSIS AND INTERVENTIONS: Right renal injury with multiple extravasations and right 8th intercostal arterial injury were detected during angiography. Emergent exploration with lateral thoracotomy was performed to manage right hemothorax. Pulsating bleeding from the thoracic roof observed in the operative field suggested a subclavian arterial injury. The unstable vital signs did not recover despite massive transfusion, and his right arm had already stiffened. Therefore, endovascular approach was adopted and the second portion of the right subclavian artery was embolized using microcoils and thrombin. OUTCOMES: Postoperative intensive care unit management performed to resuscitate patient from multiorgan failure included continuous renal replacement therapy (CRRT). After confirming the demarcation lines, transhumeral amputation of the right arm was performed on admission day 12. The patient recovered from multiorgan failure for more than 3 weeks after the accident; however, the patient survived. LESSONS: Limb salvage, albeit critical for quality of life, is not possible in some cases where life-saving measures require its sacrifice. In these cases, quick decision-making by the surgeon is paramount for patient survival. As illustrated in this case, endovascular approaches should be considered less invasive measures to save the patient's life.

Early Predictors of Recovery From Nonoperatively Treated Achilles Tendon Rupture: 1 Year Follow-Up Study.

PURPOSE: To investigate early structural and mechanical predictors of plantarflexor muscle strength and the magnitude of Achilles tendon (AT) nonuniform displacement at 6 and 12 months after AT rupture. METHODS: Thirty-five participants (28 males and 7 females; mean ± SD age 41.7 ± 11.1 years) were assessed for isometric plantarflexion maximal voluntary contraction (MVC) and AT nonuniformity at 6 and 12 months after rupture. Structural and mechanical AT and plantarflexor muscle properties were measured at 2 months. Limb asymmetry index (LSI) was calculated for all variables. Multiple linear regression was used with the 6 and 12 month MVC LSI and 12 month AT nonuniformity LSI as dependent variables and AT and plantarflexor muscle properties at 2 months as independent variables. The level of pre- and post-injury sports participation was inquired using Tegner score at 2 and 12 months (scale 0-10, 10 = best possible score). Subjective perception of recovery was assessed with Achilles tendon total rupture score (ATRS) at 12 months (scale 0-100, 100=best possible score). RESULTS: Achilles tendon resting angle (ATRA) symmetry at 2 months predicted MVC symmetry at 6 and 12 months after rupture (ß = 2.530, 95% CI 1.041-4.018, adjusted R2 = 0.416, p = 0.002; ß = 1.659, 95% CI 0.330-2.988, adjusted R2 = 0.418, p = 0.016, respectively). At 12 months, participants had recovered their pre-injury level of sports participation (Tegner 6 ± 2 points). The median (IQR) ATRS score was 92 (7) points at 12 months. CONCLUSION: Greater asymmetry of ATRA in the early recovery phase may be a predictor of plantarflexor muscle strength deficits up to 1 year after rupture. TRIAL REGISTRATION: This research is a part of "nonoperative treatment of Achilles tendon rupture in Central Finland: a prospective cohort study" that has been registered in ClinicalTrials.gov (NCT03704532).

The Injury Mechanism of Achilles Tendon Rupture in Professional Athletes: A Video Analysis Study.

BACKGROUND: In professional athletes, Achilles tendon ruptures are devastating injuries, often resulting in season loss or decreased return to sports level. We aimed to perform a comprehensive video analysis to describe the mechanisms of Achilles tendon rupture as well as body posture in professional athletes. We hypothesized that Achilles tendon ruptures in professional athletes develop with a specific injury mechanism and that body posture at the time of injury varies by sport. METHODS: Of 114 identified Achilles tendon ruptures that occurred in professional athletes between 1970 and 2020, 42 with adequate video data were analyzed for injury mechanism, body posture, and player and sport characteristics by three independent reviewers. RESULTS: Mean ± SD age of the 42 athletes (41 men and 1 woman) was 28.4 ± 4.26 years. Eighteen athletes played basketball (42.9%), 14 football (33.3%), five soccer (11.9%), three baseball (7.1%), and two rugby (4.8%). Thirty-five patients (83.3%) had noncontact injuries. The most frequent months of injury were January (16.7%) and October (14.3%). During Achilles tendon rupture, the ankle was in dorsiflexion, the body was bent forward, the knee and hip were in extension, and the foot was in a neutral position. Most injuries occurred during take-off/acceleration (40.5%) or stop and turn (38.5%) maneuvers. CONCLUSIONS: In professional athletes, the Achilles tendon most often ruptures during take-off/acceleration. The most common position during rupture is the trunk in flexion, the knee and hip in extension, and the ankle in dorsiflexion. This information can guide professional athletes in terms of physical therapy techniques, including neuromuscular training, proprioception, and balance training specific to preventing Achilles tendon rupture.