Flexor Injury Rehabilitation Splint Trial (FIRST): protocol for a pragmatic randomised controlled trial comparing three splints for finger flexor tendon repairs.

BACKGROUND: Without surgical repair, flexor tendon injuries do not heal and patients' ability to bend fingers and grip objects is impaired. However, flexor tendon repair surgery also requires optimal rehabilitation. There are currently three custom-made splints used in the rehabilitation of zone I/II flexor tendon repairs, each with different assumed harm/benefit profiles: the dorsal forearm and hand-based splint (long), the Manchester short splint (short), and the relative motion flexion splint (mini). There is, however, no robust evidence as to which splint, if any, is most clinical or cost effective. The Flexor Injury Rehabilitation Splint Trial (FIRST) was designed to address this evidence gap. METHODS: FIRST is a parallel group, superiority, analyst-blind, multi-centre, individual participant-randomised controlled trial. Participants will be assigned 1:1:1 to receive either the long, short, or mini splint. We aim to recruit 429 participants undergoing rehabilitation following zone I/II flexor tendon repair surgery. Potential participants will initially be identified prior to surgery, in NHS hand clinics across the UK, and consented and randomised at their splint fitting appointment post-surgery. The primary outcome will be the mean post-randomisation score on the patient-reported wrist and hand evaluation measure (PRWHE), assessed at 6, 12, 26, and 52 weeks post randomisation. Secondary outcome measures include blinded grip strength and active range of movement (AROM) assessments, adverse events, adherence to the splinting protocol (measured via temperature sensors inserted into the splints), quality of life assessment, and further patient-reported outcomes. An economic evaluation will assess the cost-effectiveness of each splint, and a qualitative sub-study will evaluate participants' preferences for, and experiences of wearing, the splints. Furthermore, a mediation analysis will determine the relationship between patient preferences, splint adherence, and splint effectiveness. DISCUSSION: FIRST will compare the three splints with respect to clinical efficacy, complications, quality of life and cost-effectiveness. FIRST is a pragmatic trial which will recruit from 26 NHS sites to allow findings to be generalisable to current clinical practice in the UK. It will also provide significant insights into patient experiences of splint wear and how adherence to splinting may impact outcomes. TRIAL REGISTRATION: ISRCTN: 10236011.

Endoscopic peroneus brevis tendon transfer for chronic ruptures of the Achilles tendon: surgical technique.

Chronic Achilles tendon rupture is usually defined as a rupture diagnosed 4-6 weeks after injury. The management of chronic Achilles tendon rupture (CATR) is a topic of hot debate, and no consensus has been achieved. Surgical management of CATR is recommended. Several approaches, techniques, and grafts have been described. Open techniques carry a high risk of wound breakdown, infection, and necessitate long rehabilitation times. Surgical techniques with smaller incisions to reduce the risk of scar fibrosis, pain, and infection are becoming common. The ipsilateral tendon of the hallux flexor longus and the peroneus brevis is commonly used. Endoscopic transfer of the peroneus brevis tendon is an innovative alternative to other procedures, with comparable results of other autografts even in elite athletes. The tendon of the peroneus brevis is harvested by tendoscopy before performing a calcaneal tendon endoscopy and fixing the graft in a calcaneal tunnel using an interference screw. After surgery, an anterior splint is placed for 3 weeks with immediate forefoot weight bearing. The rehabilitation starts on the 15th postoperative day.

Spontaneous tendon or ligament ruptures in patients undergoing dialysis: First pediatric case report and literature review.

Spontaneous tendon or ligament ruptures are quite rare and mostly associated with chronic systemic diseases such as diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, and chronic kidney disease (CKD). In this study, we present the first documented case of a spontaneous rupture of the medial patellofemoral ligament (MPFL) in a pediatric patient. The patient was undergoing long-term peritoneal dialysis (PD) and had a history of severe secondary hyperparathyroidism. Additionally, we discussed spontaneous tendon and ligament ruptures associated with CKD or dialysis through a comprehensive literature review. This case report highlights the importance of recognizing that spontaneous tendon or ligament injuries are not exclusive to adults; children with CKD can also be affected. Several factors including poor parathyroid hormone (PTH) and metabolic acidosis control, prolonged CKD duration and presence of malnutrition play role in the pathogenesis. Early diagnosis is crucial as it allows for timely surgical intervention and leads to a favorable functional recovery.

Reliability and validation of the German Achilles tendon Total Rupture Score.

PURPOSE: Patient-related outcome measures (PROMs) are important instruments to evaluate efficacy of orthopaedic procedures. The Achilles tendon Total Rupture Score (ATRS) is a PROM developed to evaluate outcomes after treatment of Achilles tendon ruptures (ATRs). Purpose of this study is to develop and culturally adapt the German version of the ATRS and to evaluate reliability and validity. METHODS: The ATRS was translated by forward-backward translation based on common guidelines. In this retrospective study, 48 patients with a surgical intervention after ATR were recruited. Reliability was evaluated by intraclass correlation coefficient (ICC) and Cronbach's alpha. Construct validity was valued by determining Pearson correlation coefficient with the German version of the Foot and Ankle Outcome Score (FAOS) and the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A). RESULTS: The German Version of the ATRS has an excellent internal consistency (Cronbach's alpha 0.96) as well as an excellent test-retest-reliability (ICC 0.98). It has a moderately strong correlation with the VISA-A (r = 0.73) as well as with the FAOS subclasses (r = 0.6-0.79). CONCLUSION: The German version of the ATRS demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in patients with Achilles tendon Rupture. LEVEL OF EVIDENCE: Level II.

Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making.

The purpose of this current concepts review is to highlight the evaluation and workup of hamstring injuries, nonoperative treatment options, and surgical decision-making based on patient presentation and injury patterns. Hamstring injuries, which are becoming increasingly recognized, affect professional and recreational athletes alike, commonly occurring after forceful eccentric contraction mechanisms. Injuries occur in the proximal tendon at the ischial tuberosity, in the muscle belly substance, or in the distal tendon insertion on the tibia or fibula. Patients may present with ecchymoses, pain, and weakness. Magnetic resonance imaging remains the gold standard for diagnosis and may help guide treatment. Treatment is dictated by the specific tendon(s) injured, tear location, severity, and chronicity. Many hamstring injuries can be successfully managed with nonoperative measures such as activity modification and physical therapy; adjuncts such as platelet-rich plasma injections are currently being investigated. Operative treatment of proximal hamstring injuries, including endoscopic or open approaches, is traditionally reserved for 2-tendon injuries with >2 cm of retraction, 3-tendon injuries, or injuries that do not improve with 6 months of nonoperative management. Acute surgical treatment of proximal hamstring injuries tends to be favorable. Distal hamstring injuries may initially be managed nonoperatively, although biceps femoris injuries are frequently managed surgically, and return to sport may be faster for semitendinosus injuries treated acutely with excision or tendon stripping in high-level athletes.

Distal forearm squeeze test for the diagnosis of digital flexor tendon injuries.

BACKGROUND: The forearm/wrist squeeze/compression test has been used to examine digital flexor tendon injuries with varied names. Furthermore, the test has not been minutely described and its mechanism remains unclear. We renamed the test the "distal forearm squeeze test". The purpose of this study was to elaborate on the test and elucidate the mechanism. METHODS: Two patients with digital flexor tendons ruptured in zone 3 and zone 1 respectively and 50 outpatients with intact digital tendons underwent the test. Then the test was performed on 3 chickens under 4 conditions. First, when the digital flexor and extensor tendons were all intact. Second, after the flexor tendons of the third toe were transected. Third, after the flexor tendons of all toes of the foot were transected. Finally, after the flexor and extensor tendons of all toes of the foot were transected. RESULTS: In the patient with digital flexor tendons ruptured in zone 3, the test showed that the injured digit was flexed slightly while the uninjured digits were flexed obviously. In the patient with digital flexor tendon ruptured in zone 1, after separate stabilization of the proximal interphalangeal (PIP) joints of the injured and uninjured fingers in extension, the test showed that the distal interphalangeal joint of the patient's injured finger had no response, while those of the uninjured fingers were flexed. All 50 subjects showed clenched or half-clenched hands in response to the test. The test showed that all toes were flexed when the digital tendons of the chicken were intact. All toes were flexed except the third toe after the flexor tendons of the third toe were transected. All toes were extended after all the digital flexor tendons were transected. All toes had no response after all the digital flexor and extensor tendons were transected. CONCLUSIONS: The distal forearm squeeze test is valuable in examining digital flexor tendon injuries. If only the flexor digitorum profundus tendon is examined, the PIP joint of the finger should be stabilized in extension during the test.

iTRAQ-based proteomics reveals potential markers and treatment pathways for acute Achilles tendon rupture.

BACKGROUND: Due to its limited blood supply and irregular mechanical loading, the Achilles tendon is the most frequently ruptured tendon. Despite the rising incidence of acute Achilles tendon rupture (AATR), the optimal treatment remains controversial. Missed diagnoses and delayed treatments lead to poor outcomes and limited treatment options. This study aimed to identify potential biomarkers for diagnosing and developing therapies for AATR. METHODS: We employed the coupled isobaric tag for relative and absolute quantitation-liquid chromatography-electrospray ionization-tandem mass spectrometry approach to investigate protein expression in tissues from AATR patients. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify differentially expressed proteins (DEPs) between AATR patients and healthy individuals. A protein-protein interaction (PPI) network of DEPs was constructed using the Search Tool for the Retrieval of Interacting Genes. The screened hub genes were selectively verified by immunohistochemical staining. RESULTS: We identified 410 DEPs between AATR patients and controls. The DEPs were significantly enriched in GO terms such as the extracellular region, extracellular region part, and defense response, as well as KEGG pathways, including complement and coagulation cascades, focal adhesion, and regulation of actin cytoskeleton. The main hub nodes in the PPI network comprised fibronectin 1 (FN1), major histocompatibility complex, class I, B (HLA-B), filamin A (FLNA), heat shock 27-kDa protein 1 (HSPB1), heat shock protein family A member 5 (HSPA5), apolipoprotein A4 (APOA4), and myosin IC (MYO1C). Although APOA4 and collagens I, II, and III were detectable in healthy tendons, immunohistochemical staining confirmed higher expression of these proteins in the acutely ruptured Achilles tendon. CONCLUSIONS: Our findings lay a foundation for further molecular studies of AATR. Inflammation and age-related degeneration may contribute to the pathogenesis of AATR. Moreover, the identified DEPs could be potential biomarkers for AATR diagnosis and treatment.

One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures.

OBJECTIVE: Misdiagnosed/chronic Achilles tendon injuries are rare and disabling for patients. The surgical treatment of these rare injuries aims to ensure the tendon heals mechanically and biologically. This is the prerequisite for a good clinical and functional outcome and reduces recurrences. The main aim of the study is to present a surgical technique that has proven to be original, reproducible, and capable of guaranteeing solid tendon repair and optimal tissue regeneration. METHODS: We treated five patients, four males and one female, with the one-step double augmentation technique. All patients of this study complained of pain, but above all severe functional limitation that Achilles tendon injury had been causing for more than a month. In this study, we widely described the surgical technique, original and not found in the literature, which provides a biological graft (allograft of decellularized dermis) and homologous, thrombin-activated, platelet-rich plasma (H-PRP) in a single step. Surgical approach, always used by the first author, respected predefined steps: careful dissection and preparation of the peritendinous tissues from suture to the end of the procedure, tenorrhaphy, and augmentation with allopatch to obtain a mechanically effective repair to avoid recurrences, and finally "biological" augmentation with a unit of homologous, thrombin activated, PRP. We offered to all patients a regenerative rehabilitation program post-operatively. RESULTS: All patients were evaluated clinically (functional clinical tests and questionnaires) and instrumentally (elastic-sonography and perfusion MRI). The obtained results have been evaluated at a minimum follow-up of 18 months and a maximum of 24 months. In all patients pain was resolved, and district function and kinetic chains improved with resumption of daily activities, work, and sports. CONCLUSION: The present study confirmed the regenerative potential of decellularized dermis allograft and PRP (homologous and thrombin-activated). The same approach can also be exploited in cases of severe tendon destructuring and limited "intrinsic" regenerative potential at any age. The proposed one-step surgical technique of a double augmentation therefore appears useful, safe, reproducible, and applicable in all chronic tendon lesions with low regenerative potential.

Clinical Practice Update: Achilles Tendon Rupture.

Achilles tendon rupture is a common injury. It most often occurs in middle aged men who participate in recreational sports. The injury classically presents with a loud popping noise and immediate pain and weakness of the lower extremity during actions such as jumping or running. The diagnosis is made clinically, but an MRI is often obtained for confirmation of rupture and to aid in surgical planning. Treatment is either operative, with open or minimally invasive approaches, or non-operative, with functional bracing or plaster casting. Surgical treatment was preferred for much of the 20th century, but non-operative treatment has gained significant favor in the past 15 years as new evidence has demonstrated similar long-term outcomes to surgery. Neither treatment option is currently considered superior to the other in all cases. Surgery is associated with a risk for surgical complications and is, therefore, often a poor option for the elderly and those with significant comorbidities. Non-operative management is associated with an increased risk for re-injury which is often undesirable for young and highly active patients. Ultimately, the goals and priorities of each individual patient should guide the decision of which treatment option to pursue.

Isolated popliteus tendon injury in a young patient: A case report.

Isolated popliteus injury is a rare clinical condition which can be treated either surgically or conservatively. Factors such as the patient's age, activity level, and cooperation with the medical team are determinants to choose the most optimal treatment option. A 29-year-old female patient presented with a knee injury caused by a low-speed motorcycle accident. Further examination suggested an isolated popliteus injury without any concomitant knee injury. We opted for surgical treatment, as it allowed us to act more confidently in the postoperative follow-up and the patient did not inspire confidence in the medical team in terms of close follow-up and compliance with the physical therapy protocols that would be required, if conservative treatment was chosen. In conclusion, isolated popliteus injury is a rare condition with no consensus on the treatment algorithm. Both surgical and conservative treatments can yield good to excellent results. Surgical treatment may be considered in selected cases where an optimal close follow-up regimen seems to be unlikely.

Use of the forgotten joint score (FJS)-12 to evaluate knee awareness after quadriceps tendon reconstruction.

BACKGROUND: Quadriceps tendon rupture (QTR) is a severe injury of the knee extensor apparatus. The study aims to validate the use of forgotten joint score (FJS-12) for functional outcome assessing after surgical treatment of QTR. METHODS: Fifty-seven patients who underwent surgery for QTR with transosseous suture reconstruction in a single orthopaedic surgery and traumatology center between 2015 and 2020 were eligible for enrolment in this retrospective case series. The demographic data and other pre-operative details such as age, gender, comorbidities and medication use also were extracted from the medical records. Patient reported outcome measures (PROMs) were gathered in the form of Western Ontario and McMaster Universities Arthritis Index Score (WOMAC), Tegner Activity Score (TAS), Lysholm Score and FJS-12 at a mean follow-up time of 49.84 months ± 20.64 months. The FJS-12 was validated by correlation with WOMAC, TAS and Lysholm Score. RESULTS: The mean age of all patients were 69.2 ± 13.6 years with 51 (89.5%) males and 6 (10.5%) females. The mean time from injury to surgery was 3.39 ± 5.46 days. All patients reported satisfactory functional outcomes after surgery on FJS-12, WOMAC and Lysholm scores, except the TAS, which decreased slightly from pre-operative level. There was a high negative correlation between WOMAC and FJS-12, but moderate positive correlations between FJS-12 and TAS and Lysholm scores. The Cronbach's alpha value was 0.96 for 12 items in FJS-12. CONCLUSION: This study has found that FJS-12 is a reliable and easy to assess tool for functional outcomes after QTR reconstruction. It has shown moderate to strong correlation with other commonly used outcome measures (WOMAC, TAS and Lysholm).

No difference in clinical outcomes between operative and nonoperative management of minimally retracted proximal hamstring ruptures.

PURPOSE: The indications for surgical treatment of proximal hamstring ruptures are continuing to be refined. The purpose of this study was to compare patient-reported outcomes (PROs) between patients who underwent operative or nonoperative management of proximal hamstring ruptures. METHODS: A retrospective review of the electronic medical record identified all patients who were treated for a proximal hamstring rupture at our institution from 2013 to 2020. Patients were stratified into two groups, nonoperative or operative management, which were matched in a 2:1 ratio based on demographics (age, gender, and body mass index), chronicity of the injury, tendon retraction, and number of tendons torn. All patients completed a series of PROs including the Perth Hamstring Assessment Tool (PHAT), Visual Analogue Scale for pain (VAS), and the Tegner Activity Scale. Statistical analysis was performed using multi-variable linear regression and Mann-Whitney testing to compare nonparametric groups. RESULTS: Fifty-four patients (mean age = 49.6 ± 12.9 years; median: 49.1; range: 19-73) with proximal hamstring ruptures treated nonoperatively were successfully matched 2:1 to 27 patients who had underwent primary surgical repair. There were no differences in PROs between the nonoperative and operative cohorts (n.s.). Chronicity of the injury and older age correlated with significantly worse PROs across the entire cohort (p < 0.05). CONCLUSIONS: In this cohort of primarily middle-aged patients with proximal hamstring ruptures with less than three centimeters of tendon retraction, there was no difference in patient-reported outcome scores between matched cohorts of operatively and nonoperatively managed injuries. LEVEL OF EVIDENCE: Level III.

Reconstruction of delayed distal biceps ruptures with a dermal matrix.

OBJECTIVES: Distal biceps tear is uncommon, with well-recognized risk factors and typical clinical presentation. Delays in surgical treatment lead to several challenges, such as tendon retraction and tendon degeneration. We present a surgical technique using a sterilized acellular dermal matrix, which provides a solution for a challenging pathology. MATERIAL AND METHODS: We present a detailed surgical technique of distal biceps reconstruction with acellular dermal matrix, performed in 4 patients, with an average time to diagnosis of 36 days (range, 28-45 days). Demographics, clinical data, range of motion and subjective satisfaction were collected. RESULTS: At a mean follow-up of 18 months, all 4 patients showed full range of motion and strength, complete recovery and previous work resumed without pain. No complications appeared during this time. CONCLUSIONS: Delayed distal biceps tear reconstruction by acellular dermal matrix showed promising results. Meticulous surgical technique using this matrix provided excellent reconstruction, with very solid anatomical repair and exceptionally good fixation, good clinical outcome and satisfied patients. LEVEL OF EVIDENCE: IV.

Comparison of the Outcomes of Flexor Tendon Repair in Zone II Using the Original and Adjusted Strickland Scores and the 400-Points Hand Test.

Background: The purpose of this study was to report the outcomes of flexor tendon repair in zone II and compare two analytic tests - the original and adjusted Strickland scores - and a global hand function test, the 400-points test. Methods: We included 31 consecutive patients (35 fingers) with a mean age of 36 years (range 19-82 years) who underwent surgery for a flexor tendon repair in zone II. All patients were treated in the same healthcare facility by the same surgical team. All the patients were followed and evaluated by the same team of hand therapists. Results: At 3 months after the surgery, we found a good outcome in 26% of patients with the original Strickland score, 66% with the adjusted one and 62% with the 400-points test. Among the 35 fingers, 13 of them were evaluated at 6 months after the surgery. All the scores had improved with 31% good outcomes in the original Strickland score, 77% in the adjusted Strickland score and 87% in the 400-points test. The results were significantly different between the original and adjusted Strickland scores. Good agreement was found between the adjusted Strickland score and the 400-points test. Conclusions: Our results suggest that flexor tendon repair in zone II remains difficult to assess based solely on an analytic test. It should be combined with an objective global hand function test, such as the 400-points test, which appears to correlate with the adjusted Strickland score. Level of Evidence: Level IV (Therapeutic).

SLAP lesion type IX: case series and a review of literature.

PURPOSE: A type IX SLAP (superior labrum anterior to posterior) lesion involves 360° of the glenohumeral labrum. Only rare reports have been published analyzing the risk factors of this lesion and the success of its arthroscopic management. The aim of our study is to evaluate predisposing factors that lead to SLAP IX and to assess the clinical outcome after arthroscopic treatment. Our treatment algorithm is also presented. METHODS: We report on a series of six patients treated in our institution between January 2014 and January 2019 who underwent shoulder arthroscopy and were intraoperatively found to have a SLAP lesion type IX. Arthroscopic labral repair and biceps tenodesis were indicated in all patients. American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Rowe Score and Constant Murley Shoulder Score (CS) were used for clinical evaluation. Patients were evaluated preoperatively and at 12 weeks, 1 year and 2 years postoperatively. RESULTS: We analyzed six patients of which 83% were males (5/6 patients). The average age at the time of surgery was 37.16 (range 30-42 years). The dominant arm was affected in 50% of patients (3/6 patients). A significant postoperative improvement was seen in all six patients. 83% (5/6) of patients returned to their pre-injury activity level. Average values of all three measured scores show a significant increase comparing preoperative to postoperative period (P-value < 0.05). All patients were able to return to work. CONCLUSIONS: The final diagnosis was established intraoperatively as 83% (5/6) of radiology reports differed from subsequent arthroscopic findings. The mechanism of injury in all our cases was high energy trauma with traction, arm in abduction or anteflexion. We observed great success with arthroscopic treatment as high percentage of our patients returned back to work and sports.

Pediatric Flexor Tendon Injuries.

The diagnosis and management of pediatric flexor tendon injuries present unique challenges to the hand surgeon. Examination of young children is not always straightforward, and tendon lacerations are frequently diagnosed late--sometimes weeks or months after the inciting injury. Four- and six-strand repair techniques are supported by recent literature, though the surgeon must remain diligent to ensure gliding of a bulky repair in a narrow tendon sheath. Beyond the operating room, postoperative management must be tailored to accommodate nuances specific to patient age and behavioral development. A fluid, patient-specific approach to every stage of management is critical for the successful treatment of pediatric flexor tendon injuries.

[Treatment of extensor tendon injuries of the hand]. / Behandlung von Strecksehnenverletzungen der Hand.

The extensor apparatus of the hand is a complex system consisting of extrinsic and intrinsic muscles, which in combination enable the individual extension of the fingers. Extensor tendon injuries of the hand are frequent injuries and the operative or conservative treatment options are determined by the localization and involvement of osseus structures. For an optimal outcome of the treatment of extensor tendon injuries, correct diagnostics and a consistent hand aftercare are absolutely essential. The crucial decision making regarding the further procedure starts with the initial patient treatment, ideally on the day of trauma.

Tibialis Anterior Tendon Rupture Surgical Treatments and Outcomes: A Systematic Review and Meta-Analysis.

Tibialis anterior tendon ruptures are a rare condition with an often-delayed diagnosis due to transient pain and compensation of remaining anterior compartment tendons. Previous systematic reviews have limited their recommendations to surgical treatment over nonoperative cares given the relatively small sample size in the literature. This current systematic review and meta-analysis was performed to compare the outcomes amongst the various surgical techniques and define factors that may affect long term patients results. Twenty-six references (217 cases) were identified. Use of extensor tendon autograft (odds ratio [OR] 5.55; I2=46%), autograft repair through semitendinosus/gracilis/ plantaris/ Achilles tendon/ peroneus longus ([OR] 4.14; I2=71%), or direct repair ([OR] 3.59; I2=57%), provided the best postoperative outcomes, whereas allograft repair ([OR] .52; I2=77%),and ipsilateral split/ turn-down tibialis anterior tendon ([OR] .69; I2=71%), were associated with poorer outcomes. Ruptures fixed in the acute phase ([OR] 8.3; I2=26%), were associated with statistically significant better outcomes when compared to these ruptures fixed in the chronic phase ([OR] .52; I2=77%). Results of this systematic review and meta-analysis suggests that ruptures should be surgically repaired in the acute phase whenever possible and comparable outcomes can be achieved through extensor tendon autograft repair, autograft repair, and direct repair.

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft: A Case Report.

CASE: A 15-year-old adolescent girl presented with a complete Achilles tendon rupture from playing netball, which was diagnosed 6 weeks later. Unfortunately, there was a significant deficit of 92 mm, and an allograft reconstruction was required to bridge the gap. CONCLUSION: Achilles tendon ruptures are rare in children and adolescents without a penetrating injury, but the diagnosis must not be missed. Achilles tendon ruptures should be considered in children with acute-onset ankle pain during running, jumping, or sudden dorsiflexion of the ankle. Tendon transfers and allograft may be required after rupture and retraction has occurred in subacute or chronic injuries.

Validity and reliability of the Thai version of the Achilles tendon total rupture score.

PURPOSE: The purpose of this study was to translate and cross-culturally adapt the Achilles Tendon Total Rupture Score (ATRS), a patient-reported outcome measurement (PROM) designed specifically to assess outcomes in patients with Achilles tendon rupture, into the Thai language and then determine its validity and reliability. METHODS: The ATRS was translated into the Thai version (Thai-ATRS) according to internationally recognized guidelines. The study included 50 patients with Achilles tendon rupture from 2003 to 2017. The web-based online assessments were conducted two weeks apart. Construction validity was determined by assessing the correlation between the Thai-ATRS and the Thai version of the Foot and Ankle Outcome Score (Thai-FAOS). Reliability was determined with Cronbach's alpha and intraclass correlation coefficients (ICC). RESULTS: The validity test displayed a strong correlation between the Thai-ATRS and the Thai-FAOS (r = 0.87). The reliability test showed good internal consistency with a Cronbach's alpha of 0.95 and excellent internal consistency with an ICC of 0.95, which represented excellent test-retest reliability. The MDC was 10.7 at the individual level and 1.5 at the group level. CONCLUSION: The Thai-ATRS was demonstrated to be valid and reliable for assessing functional outcomes in Thai patients with Achilles tendon rupture. LEVEL OF EVIDENCE: II.