Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review.

Shear wave elastography (SWE) is an emerging and promising ultrasound modality, and is more recently employed in the diagnosis of musculoskeletal (MSK) pathologies. SWE evaluates tissue stiffness by measuring the speed of propagating acoustic waves through body tissue structures. Knowing the variations in stiffness of MSK soft tissue can provide helpful diagnostic insight for the evaluation of pathology in muscles, tendons, ligaments, nerves, and other soft tissues. The goal of this review is to synthesize recent literature on the utility of SWE for MSK pathology diagnosis. This review reveals that SWE adds important diagnostic data for the evaluation of several pathologies, such as median mononeuropathy at the wrist, Achilles tendinopathy, and plantar fasciitis. The review also reveals a lack of evidence pertaining to appropriate standardization of use and the connection to reliable and valid diagnostic benefit in the clinical setting.

Hyperuricemia as an independent risk factor for achilles tendon rupture in male: a case-control study.

OBJECTIVE: To study the correlation between achilles tendon rupture (ATR) and hyperuricemia, also verify the known risk factors for ATR. METHODS: A retrospective review of 488 subjects was performed (182 with Achilles tendon rupture, 306 controls with ankle sprains). Demographic variables and risk factors for rupture were tabulated and compared. The baseline data and related indicators were compared, and the risk factors of ATR were analyzed by constructing a binary logistic regression model. RESULTS: Univariate logistic analysis showed that BMI, smoking, and hyperuricemia were risk factors for the development of ATR (OR = 1.65, 95%CI 1.13-2.42, P = 0.01; OR = 1.47, 95%CI 1.00-2.24, P < 0.05; OR = 2.85, 95%CI 1.84-4.42, P < 0.01). Multifactorial analysis showed that BMI ≥ 25 kg/m2, smoking, and hyperuricemia were independent risk factors for the development of ATR (OR = 1.66, 95%CI 1.11-2.49, P = 0.01; OR = 2.15, 95%CI 1.28-3.60, P < 0.01; OR = 3.06, 95%CI 1.92-4.89, P < 0.01). Among the blood biochemical indicators, total cholesterol (TC) and uric acid (UA) were independent risk factors for the occurrence of ATR (OR = 1.54, 95% CI 1.12-2.12, P = 0.01; OR = 1.01, 95% CI 1.01-1.01, P < 0.01). CONCLUSION: Our study confirmed that, as in previous results, higher BMI, smoking, and total cholesterol are risk factors for ATR, Hyperuricemia may contribute to the development of ATR, and adjunctive tests for TC and UA in the blood biochemistry may be helpful in predicting the risk of ATR.

A pilot study exploring the use of hyaluronic acid in treating insertional achilles tendinopathy.

PURPOSE: This study explores the use of ultrasound-guided Hyaluronic Acid (HA) injections for Insertional Achilles Tendinopathy (IAT). METHODS: A cohort of 15 ankles diagnosed with IAT received three weekly ultrasound-guided HA injections. The Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire scored the severity of symptoms and functional impairment before treatment, and at one and six months post-treatment. RESULTS: Significant improvement was observed in VISA-A scores post-treatment, rising from an average baseline of 34.8 ± 15.2 (11-63) to 53.6 ± 20.9 (15-77) after one month, and then to 50.7 ± 18.6 (20-75) after six months. No adverse reactions were noted, underscoring the safety of the intervention. CONCLUSION: The pilot study presents HA injections as a potentially effective treatment for IAT, while interpretation of these findings must take into account the variability in results, indicating a range of patient responses. It encourages further research to confirm these findings and to explore HA's full potential in managing IAT, despite the limitations of a small sample size and lack of control group.

Effect of platelet-rich plasma in Achilles tendon allograft in rabbits.

BACKGROUND: Achilles tendon is composed of dense connective tissue and is one of the largest tendons in the body. In veterinary medicine, acute ruptures are associated with impact injury or sharp trauma. Healing of the ruptured tendon is challenging because of poor blood and nerve supply as well as the residual cell population. Platelet-rich plasma (PRP) contains numerous bioactive agents and growth factors and has been utilized to promote healing in bone, soft tissue, and tendons. OBJECTIVE: The purpose of this study was to evaluate the healing effect of PRP injected into the surrounding fascia of the Achilles tendon after allograft in rabbits. METHODS: Donor rabbits (n = 8) were anesthetized and 16 lateral gastrocnemius tendons were fully transected bilaterally. Transected tendons were decellularized and stored at -80°C prior to allograft. The allograft was placed on the partially transected medial gastrocnemius tendon in the left hindlimb of 16 rabbits. The allograft PRP group (n = 8) had 0.3 mL of PRP administered in the tendon and the allograft control group (n = 8) did not receive any treatment. After 8 weeks, rabbits were euthanatized and allograft tendons were transected for macroscopic, biomechanical, and histological assessment. RESULTS: The allograft PRP group exhibited superior macroscopic assessment scores, greater tensile strength, and a histologically enhanced healing process compared to those in the allograft control group. CONCLUSIONS: Our results suggest administration of PRP on an allograft tendon has a positive effect on the healing process in a ruptured Achilles tendon.

Bioactive 3D Electrohydrodynamic Printed Lattice Architectures Augment Tenogenesis of Tendon Stem/Progenitor Cells.

Tendon defect repair remains a tough clinical procedure that hinders functional motion in patients. Electrohydrodynamic (EHD) three-dimensional (3D) printing, as a novel strategy, can controllably fabricate biomimetic micro/nanoscale architecture, but the hydrophobic and bioinert nature of polymers might be adverse to cell-material interplay. In this work, 3D EHD printed polycaprolactone (PCL) was immobilized on basic fibroblast growth factor (bFGF) using polydopamine (PDA), and the proliferation and tenogenic differentiation of tendon stem/progenitor cells (TSPCs) in vitro was researched. A subcutaneous model was established to evaluate the effects of tenogenesis and immunomodulation. We then investigated the in situ implantation and immunomodulation effects in an Achilles tendon defect model. After immobilization of bFGF, the scaffolds profoundly facilitated proliferation and tenogenic differentiation; however, PDA had only a proliferative effect. Intriguingly, the bFGF immobilized on EHD printed PCL indicated a synergistic effect on the highest expression of tenogenic gene and protein markers at 14 days, and the tenogenesis may be induced by activating the transforming growth factor-ß (TGF-ß) signal pathway in vitro. The subcutaneous engraftment study confirmed a tendon-like structure, similar to that of the native tendon, as well as an M2 macrophage polarization effect. Additionally, the bioactive scaffold exhibited superior efficacy in new collagen formation and repair of Achilles tendon defects. Our study revealed that the topographic cues alone were insufficient to trigger tenogenic differentiation, requiring appropriate chemical signals, and that appropriate immunomodulation was conducive to tenogenesis. The tenogenesis of TSPCs on the bioactive scaffold may be correlated with the TGF-ß signal pathway and M2 macrophage polarization.

The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability.

Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.

Modified gastro-soleus turn-down flap for chronic or neglected achilles tendon ruptures.

BACKGROUND: Achilles' tendon chronic rupture is a common entity that is usually misdiagnosed or mistreated. Hence, she was presented to us later or with complications affecting her gait. Surgical resection is needed to either bridge the gap or reinforce the strength of the tendon repair. OBJECTIVES: Our study's goal was to assess the clinical results of repairing chronic Achilles' tendon lesions employing the middle segment of the proximal portion of the tendon (gastro-soleus), as a turn-down flap. METHODS: Our prospective interventional single arm study included 18 patients with chronic Achilles' tendon rupture attending at Al-Azhar university hospitals in Cairo, Egypt from May 2020 to April 2023. Diagnosis of the patients was confirmed by radiographic and clinical investigations. They were all treated with the same open reconstruction procedure using a modified GSF. The average follow-up was 12 months. The results of this study were assessed by the Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) score, and capacity to perform repeated heel raises on the affected side. RESULTS: The mean operative time was 72.77 min. The median (IQR) time of reconstruction was 10 (8-12) after the injury. The median (IQR) length of flab was 4.5 (4.3-5) 9 (Table 2). No intraoperative complications occurred. The typical follow-up period was 12 months (6-18 months). In terms of the ATRS, we found a significant reduction from 82.8 ± 3 preoperatively to 20.8 ± 6.7 at 12 months postoperatively (P value = 0.001). As regards the AOFAS score, it was increased from 49.5 ± 10 preoperatively to 83.8 ± 8.5 12 months postoperatively (P = 0.001). In terms of the post operative complications, there was no re-rupture. Two patients experienced superficial wound infection which improved with daily dressing and antibiotics. Additionally, two patients had slight ankle stiffness four months after the operation, which improved after programmed rehabilitation at the sixth month. CONCLUSION: The modified GSTF is a simple, safe, well-tolerated and effective method of treatment with excellent functional results and greater patient content.

Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men.

Human tendons adapt to mechanical loading, yet there is little information on the effect of the temporal coordination of loading and recovery or the dose-response relationship. For this reason, we assigned adult men to either a control or intervention group. In the intervention group, the two legs were randomly assigned to one of five high-intensity Achilles tendon (AT) loading protocols (i.e., 90% maximum voluntary contraction and approximately 4.5 to 6.5% tendon strain) that were systematically modified in terms of loading frequency (i.e., sessions per week) and overall loading volume (i.e., total time under loading). Before, at mid-term (8 weeks) and after completion of the 16 weeks intervention, AT mechanical properties were determined using a combination of inverse dynamics and ultrasonography. The cross-sectional area (CSA) and length of the free AT were measured using magnetic resonance imaging pre- and post-intervention. The data analysis with a linear mixed model showed significant increases in muscle strength, rest length-normalized AT stiffness, and CSA of the free AT in the intervention group (p < 0.05), yet with no marked differences between protocols. No systematic effects were found considering the temporal coordination of loading and overall loading volume. In all protocols, the major changes in normalized AT stiffness occurred within the first 8 weeks and were mostly due to material rather than morphological changes. Our findings suggest that-in the range of 2.5-5 sessions per week and 180-300 s total high strain loading-the temporal coordination of loading and recovery and overall loading volume is rather secondary for tendon adaptation.

Gastrocnemius medialis and Achilles tendon properties do not differ between children with unilateral or bilateral spastic cerebral palsy.

Spastic cerebral palsy (SCP) is a common neurodevelopmental disorder in children, which can be categorized into unilateral and bilateral subtypes. Most studies examining the muscle-tendon properties of the lower extremities in individuals with SCP do not distinguish between subtypes. However, spastic muscle morphology is an important determinant for its function. Therefore, differences in muscle-tendon pathology might lead to different treatment strategies. The aim of this retrospective study was to investigate the muscle-tendon properties between children with unilateral SCP and those with bilateral SCP. Overall, 33 ambulatory children (15 with unilateral SCP and 18 with bilateral SCP, Gross Motor Function Classification System Level I-III) were included. Ankle joint range of motion, isometric muscle strength, and muscle-tendon properties of the gastrocnemius medialis (GM) muscle-tendon unit (MTU) (e.g., muscle volume, tissue lengthening behavior) were assessed with isokinetic dynamometry, 3D motion capture, and ultrasound, respectively. Independent t-tests or Mann-Whitney tests were used to test for group differences (α = 0.05). Effect sizes (Cohen's d) were also calculated. No significant differences in any assessed parameter were found between children with unilateral SCP and children with bilateral SCP (p > 0.05, d < 0.57). Our findings suggest that the functional and morphological properties of the GM MTU are similarly developed in children with unilateral SCP and children with bilateral SCP. We assume that activity levels might be the decisive factor. Nonetheless, our investigations need be extended by including gait parameters and associated tissue dynamics.

A Passive Ankle Dorsiflexion Testing System for an In Vivo Model of Overuse-induced Tendinopathy.

Tendinopathy is a chronic tendon condition that results in pain and loss of function and is caused by repeated overload of the tendon and limited recovery time. This protocol describes a testing system that cyclically applies mechanical loads via passive dorsiflexion to the rat Achilles tendon. The custom-written code consists of pre- and post-cyclic loading measurements to assess the effects of the loading protocol along with the feedback control-based cyclic fatigue loading regimen. We used 25 Sprague-Dawley rats for this study, with 5 rats per group receiving either 500, 1,000, 2,000, 3,600, or 7,200 cycles of fatigue loads. The percentage differences between the pre- and post-cyclic loading measurements of the hysteresis, peak stress, and loading and unloading moduli were calculated. The results demonstrate that the system can induce varying degrees of damage to the Achilles tendon based on the number of loads applied. This system offers an innovative approach to apply quantified and physiological varying degrees of cyclic loads to the Achilles tendon for an in vivo model of fatigue-induced overuse tendon injury.

Predictive Measurement for Windlass Change in Length and Selected Treatment Outcomes in Chronic Plantar Fasciitis.

Approximately 10% of patients with plantar fasciitis experience persistent and often severe symptoms, though little is known about its etiology. The goal of this study was to employ an objective, simple, and economical approach to measure the change in length of the windlass and assess the efficiency of a specified therapy protocol applied in this study over a one-month period. Age, weight, normal foot type, and gender were employed as matching factors in a matched design. Fifty individuals diagnosed with unilateral plantar fasciitis and an equal number of healthy volunteers all fulfilled the inclusion criteria and took part in this research. Pain assessment utilized a visual analogue scale and the pain subscale of the foot function index, while a valid goniometric method was employed to evaluate weight-bearing windlass, dorsiflexion and plantar flexion ranges of motion. Additionally, foot plantar pressure (both static and dynamic measures) and tape measurement of windlass change in length were assessed. The assessment was completed by all patients before and after their treatment program. Normal subjects were evaluated for control. Treatment methods encompassed ultrasonic therapy, application of an electrical heating pad, utilization of a night splint, engagement in stretching activities for the plantar aponeurosis and Achilles tendon, as well as both extrinsic and intrinsic strengthening exercises. After one month, the patients were reassessed and compared to control volunteers. In those suffering from plantar fasciitis, a substantial link was found between clinical measurements (tape measurement, windlass range of motion) and foot plantar pressure, indicating improvement. The chosen treatment protocol was effective in 96% of patients. For windlass length change, the measurement technique was found to be valid and objective. The chosen therapy procedure was successful in treating persistent plantar fasciitis in patients.

Needle­based gastrocnemius lengthening: a novel ultrasound­guided noninvasive technique: part II-clinical results.

BACKGROUND: Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens. METHODS AND RESULTS: We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18-64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle. RESULTS: Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months. CONCLUSION: Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.

Achilles Tendon Stiffness in the Etiology of Sever Disease: A Shear Wave Elastography Study.

BACKGROUND: Sever disease is one of the most common causes of heel pain in growing children and adolescents. There is no consensus about etiology of Sever disease. METHODS: The study comprised 41 participants aged 8 to 13 years who visited the orthopedic outpatient clinic: 17 patients with Sever disease and 24 asymptomatic children. The middle third segment of the body of the Achilles tendon and the calcaneal insertion zone were separately assessed. Five measuring points for the quantitative value of each point were randomly selected. The color scale used in the Young's modulus shows the lowest values in blue and the highest values in red. The mean values were used for the statistical analysis. RESULTS: Less elasticity was detected at the insertional site for the control group (4.02 kPa versus 3.65 kPa), the situation was reversed in the body of the Achilles tendon and the elasticity of the study group was less than that of the control group (241.0 kPa versus 260.5 kPa). However, no statistically significant difference was found between the groups. CONCLUSIONS: In conclusion, no difference was found in Achilles tendon elasticity between patients with Sever disease and healthy individuals in both the tendon body and the calcaneal insertionof the tendon. Achilles tendon elasticity has not been found to play a role in the etiology of Sever disease.

Mild untreated hypercholesterolaemia affects mechanical properties of the Achilles tendon but not gastrocnemius muscle.

Tendon xanthoma and altered mechanical properties have been demonstrated in people with familial hypercholesterolaemia. However, it is unclear whether mild, untreated hypercholesterolaemia alters musculotendinous mechanical properties and muscle architecture. We conducted a case-control study of adults aged 50 years and over, without lower limb injury or history of statin medication. Based on fasting low-density lipoprotein (LDL) cholesterol levels, 6 participants had borderline high LDL (>3.33 mmol/L) and 6 had optimal LDL cholesterol (<2.56 mmol/L). Using shear wave elastography, shear wave velocity (SWV) of the Achilles tendon and gastrocnemius medialis muscle (a proxy for stiffness), along with muscle fascicle length and pennation angle were measured under four passive tensile loads (0, 0.5, 1.0, 1.5 kg) applied via a pulley system. Differences between groups were found for tendon SWV but not muscle SWV, fascicle length or pennation angle. Participants with hypercholesterolaemia showed greater SWV (mean difference, 95 % CI: 2.4 m/s, 0.9 to 4.0, P = 0.024) compared to the control group across all loads. These findings suggest that adults with mild hypercholesterolaemia have increased tendon stiffness under low passive loads, while muscle was not affected. Future research is needed to confirm findings in a larger cohort and explore the impact of hypercholesterolaemia on tendon fatigue injury and tendinopathy.

Acellular porcine Achilles tendon patch encapsulating tendon-derived stem cells for rotator cuff repair in a rabbit model.

Currently, the predominant method for repairing rotator cuff involves surgical suture techniques, but the failure rate remains notably high. Failure of the rotator cuff insertion to provide adequate biomechanics during early healing is considered a major cause of failure. Addressing this problem, biological augmentation emerges as a promising strategy for enhancing the biomechanical properties during early stages. Tendon-derived stem cells (TDSCs), which facilitate the differentiation of repair-supportive cells, hold the potential to improve the efficacy of patch application. The study aims to assess the behavior of TDSCs in acellular porcine Achilles tendon (APAT) patches and to explore the capacity of the APAT patch encapsulating TDSCs in promoting both tendon-to-bone healing and biomechanical enhancements in a rabbit rotator cuff repair model. Transmission electron microscopy (TEM) analyses validated the complete cellular clearance of native cells from APAT patches, with uniform distribution of TDSCs. Immunofluorescence staining confirmed successful TDSCs attachment, while population doubling time (PDT) underscored increased TDSCs proliferation on APAT patches. Quantitative polymerase chain reaction (qPCR) demonstrated upregulation of tenocyte and osteocyte related genes in TDSCS cultured within the patches. In the subsequent in vivo experiment, fifty-four rabbits were used to create rotator cuff injury models and randomly assigned to a control group, an APAT patch group, and an APAT patch with TDSCs group. Histological analysis showed that the APAT patch with TDSCs group had significantly enhanced tendon-to-bone healing and a distinctly organized tendon-fibrocartilage-bone structure, as compared to the APAT patch group. In addition, the biomechanical properties of the APAT patch with TDSCs group were significantly improved. In conclusion, APAT patches promote TDSC proliferation and stimulate tenogenic and osteogenic differentiation. APAT patches encapsulating TDSCs have shown considerable potential in promoting tendon-to-bone healing of rotator cuff injuries, indicating that their use in rotator cuff repair surgery is clinically meaningful.

Per-step and cumulative load at three common running injury locations: The effect of speed, surface gradient, and cadence.

Understanding how loading and damage on common running injury locations changes across speeds, surface gradients, and step frequencies may inform training programs and help guide progression/rehabilitation after injuries. However, research investigating tissue loading and damage in running is limited and fragmented across different studies, thereby impairing comparison between conditions and injury locations. This study examined per-step peak load and impulse, cumulative impulse, and cumulative weighted impulse (hereafter referred to as cumulative damage) on three common injury locations (patellofemoral joint, tibia, and Achilles tendon) across different speeds, surface gradients, and cadences. We also explored how cumulative damage in the different tissues changed across conditions relative to each other. Nineteen runners ran at five speeds (2.78, 3.0, 3.33, 4.0, 5.0 m s-1 ), and four gradients (-6, -3, +3, +6°), and three cadences (preferred, ±10 steps min-1 ) each at one speed. Patellofemoral, tibial, and Achilles tendon loading and damage were estimated from kinematic and kinetic data and compared between conditions using a linear mixed model. Increases in running speed increased patellofemoral cumulative damage, with nonsignificant increases for the tibia and Achilles tendon. Increases in cadence reduced damage to all tissues. Uphill running increased tibial and Achilles tendon, but decreased patellofemoral damage, while downhill running showed the reverse pattern. Per-step and cumulative loading, and cumulative loading and cumulative damage indices diverged across conditions. Moreover, changes in running speed, surface gradient, and step frequency lead to disproportional changes in relative cumulative damage on different structures. Methodological and practical implications for researchers and practitioners are discussed.

Diagnosis and management of Achilles tendon ailments: the Scottish mist.

The diagnosis and management of Achilles tendon ailments continue to be widely discussed by the scientific community. Also, the nomenclature used to describe the tendinopathic lesion in patients changed over the last decades together with the evolution in the knowledge of the physiopathology of Achilles tendinopathy, and unfortunately, through ignorance and possibly laziness, confusion still abounds. To emerge from these foggy paths, some clarifications are still necessary. The present Editorial tries to clarify some of these issues.

Comparison of percutaneous and open repair of Achilles tendon rupture: results and complications from a single institution.

BACKGROUND: The Achilles tendon is the strongest tendon in the human body, but it is prone to injury, especially in modern times when recreational sports are growing in popularity. As a result, Achilles tendon rupture is becoming an increasingly common medical problem in modern society. The main objective of this study was to compare the outcomes of percutaneous repair and open repair for the treatment of Achilles tendon rupture. METHODS: A retrospective study was conducted involving a total of 316 patients who had undergone surgical treatment for Achilles tendon rupture between 2013 and 2021. The data collected from the medical history of these patients included the type of surgical procedure, the mechanism of injury, the age and sex of the patients, the time spent in the hospital, and any possible complications of the surgical treatment (such as infections, reruptures, or sural nerve injuries). RESULTS: The study revealed that there was no significant difference between percutaneous and open surgical approaches in terms of sural nerve injury. However, there was a statistically significant advantage of the percutaneous method in terms of the number of infections, which was significantly lower than that of the open method. Additionally, the median length of hospital stay was found to be four days longer with the open approach. However, the study noted that a statistically significant advantage of the percutaneous method for rerupture could not be established due to the small number of patients with rerupture and the insufficient ratio of patients with rerupture in relation to the size of the observed population. CONCLUSIONS: Percutaneous repair is an effective treatment option for Achilles tendon rupture and has outcomes equal to or better than those of open repair. Therefore, this approach is recommended as the preferred method of treatment due to the presence of fewer complications, provided that the indications for this technique are appropriate.