Aims. To determine whether platelet-rich plasma (PRP) injection improves outcomes two years after acute Achilles tendon rupture. Methods. A randomized multicentre two-arm parallel-group, participant- and assessor-blinded superiority trial was undertaken. Recruitment commenced on 28 July 2015 and two-year follow-up was completed in 21 October 2019. Participants were 230 adults aged 18 years and over, with acute Achilles tendon rupture managed with non-surgical treatment from 19 UK hospitals. Exclusions were insertion or musculotendinous junction injuries, major leg injury or deformity, diabetes, platelet or haematological disorder, medication with systemic corticosteroids, anticoagulation therapy treatment, and other contraindicating conditions. Participants were randomized via a central online system 1:1 to PRP or placebo injection. The main outcome measure was Achilles Tendon Rupture Score (ATRS) at two years via postal questionnaire. Other outcomes were pain, recovery goal attainment, and quality of life. Analysis was by intention-to-treat. Results. A total of 230 participants were randomized, 114 to PRP and 116 to placebo. Two-year questionnaires were sent to 216 participants who completed a six-month questionnaire. Overall, 182/216 participants (84%) completed the two-year questionnaire. Participants were aged a mean of 46 years (SD 13.0) and 25% were female (57/230). The majority of participants received the allocated intervention (219/229, 96%). Mean ATRS scores at two years were 82.2 (SD 18.3) in the PRP group (n = 85) and 83.8 (SD 16.0) in the placebo group (n = 92). There was no evidence of a difference in the ATRS at two years (adjusted mean difference -0.752, 95% confidence interval -5.523 to 4.020; p = 0.757) or in other secondary outcomes, and there were no re-ruptures between 24 weeks and two years. Conclusion. PRP injection did not improve patient-reported function or quality of life two years after acute Achilles tendon rupture compared with placebo. The evidence from this study indicates that PRP offers no patient benefit in the longer term for patients with acute Achilles tendon rupture. Cite this article: Bone Joint J 2022;104-B(11):1256–1265

Aims

Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation.

Aims

Avulsion of the proximal hamstring tendon origin can result in significant functional impairment, with surgical re-attachment of the tendons becoming an increasingly recognized treatment. The aim of this study was to assess the outcomes of surgical management of proximal hamstring tendon avulsions, and to compare the results between acute and chronic repairs, as well as between partial and complete injuries.

Aims. To examine the rates of hamstring graft salvage with arthroscopic debridement of infected anterior cruciate ligament (ACL) reconstruction as reported in the literature and discuss functional outcomes. Materials and Methods. A search was performed without language restriction on PubMed, EMBASE, Ovid, CINAHL and Cochrane Register of Controlled Trials (CENTRAL) databases from their inception to April 2015. We identified 147 infected hamstring grafts across 16 included studies. Meta-analysis was performed using a random-effects model to estimate the overall graft salvage rate, incorporating two different definitions of graft salvage. Results. The graft salvage rate was 86% (95% confidence intervals (CI) 73% to 93%; heterogeneity: tau. 2. = 1.047, I. 2. = 40.51%, Q = 25.2, df = 15, p < 0.001), excluding ACL re-ruptures. Including re-ruptures as failures, the graft salvage rate was 85% (95% CI 76% to 91%; heterogeneity: tau. 2.  = 0.099, I. 2. = 8.15%, Q = 14.15, df = 13, p = 0.36). Conclusions. Arthroscopic debridement combined with antibiotic treatment can lead to successful eradication of infection and graft salvage, with satisfactory functional outcomes in many cases of septic arthritis following ACL reconstruction. Persistent infection despite repeat arthroscopic debridements requires graft removal with the intention of revision ACL surgery at a later stage. Take home message: Arthroscopic debridement combined with antibiotic therapy is an appropriate initial approach in most cases of septic arthritis following ACL reconstruction, achieving graft salvage rates of about 85%. Cite this article: Bone Joint J 2016;98-B:608–15

This prospective study explores the outcomes of the Forth Valley Protocol (FVP) for the management of acute Achilles tendon ruptures. The protocol uses ultrasound as the primary mechanism to guide treatment. All patients presenting with acute tendoachilles rupture over a three-year period were included. Patients under 18 years of age, chronic ruptures, or prior surgery to the Achilles tendon were excluded. Patients with a gap ≤2cm had conservative management following an Early Rehabilitation Protocol (ERP) and >2cm underwent surgery (if an appropriate surgical candidate). Achilles Tendon Rupture Scores (ATRS) were obtained retrospectively. Fischer's exact test was used to determine statistical significance. 158 patients were included with a mean age of 53 (range 20–89). Ultrasound scans were obtained for 121 patients (76.5%), demonstrating a mean tendon gap of 1.61cm. 143 patients managed conservatively and 15 surgically. The overall re-rupture rate was 3.8% (n=6). All the re-ruptures occurred in patients treated conservatively, but this was not found to be statistically significant (n=6, P=1.0). The overall complication rate (excluding re-ruptures) was 1.9%. ATRS was comparable between both treatment modalities (P=0.382, 0.422), with a mean score of 86.6 in the conservative group and 81.4 in the surgical group. The FVP demonstrates low re-rupture and complication rates in line with other published studies. Patients with gaps ≤2.0cm on the ultrasound can be successfully treated conservatively with an ERP. This has potential benefits in terms improved patient outcomes, satisfaction, and preservation of resources

Objective. To evaluate early mobilization with the ‘STRONG regime’ is safe after lateral ankle ligament repair with suture tape augmentation. Background. The ESSKA-AFAS ankle instability group presented in 2016 evidence-based guidelines for rehabilitation and return to activity after lateral ankle ligament repair. Early mobilization is considered an important element of postoperative rehabilitation. Patients have to be immobilized for approximately six weeks to protect the delicate repair. Lateral ankle ligament repair with suture tape augmentation results in greater strength compared with standard repairs and early mobilization proved to be successful in small sample size studies. Augmented surgery technique is getting increasingly popular. However, it is unknown which rehabilitation regimes are used. It is essential to establish a clear evidence-based guideline for rehabilitation after surgery. Methods. A systematic literature search was performed to obtain the best evidence research regarding this surgery. In cooperation between the orthopaedic- and physical therapy department a post-operative rehabilitation protocol with early mobilization was established. This STRONG protocol (figure 1) is based on milestones and three stages. Results. In February 2016 the first patients were selected for the early mobilization regime. In total 102 patients with a lateral ankle ligament repair were treated with the STRONG protocol. No re-ruptures were observed with a follow up of a year. In a subgroup of athletes hop tests showed a symmetry index of 100,5% for triple hop, 98,6 for side hop and 103,6 for figure of 8 hop. First return to sport was achieved between 9–12 weeks, with full return to competition after a mean of 4 months. Conclusions. An early postoperative mobilization regime based on supervised exercises seems to be a safe intervention after a lateral ankle ligament reconstruction. Clinical implications. Augmented ankle ligament surgery with early mobilization could be an important advancement in treating patients with chronic ankle injuries. For any figures or tables, please contact authors directly

Abstract. Aims. Growth disturbances after transphyseal paediatric ACL reconstruction have led to the development of physeal-sparing techniques. However, evidence in their favour remains weak. This study reviews the literature to identify factors associated with growth disturbances in paediatric ACL reconstructions. Materials and Methods. Web of Science, Scopus and Pubmed were searched for case series studying paediatric ACL reconstructions. Titles, abstracts, text, results and references were examined for documentation of growth disturbances. Incidences of graft failures were also studied in these selected studies. Results. 78 studies with 2693 paediatric ACL reconstructions had 70 growth disturbances (2.6%). Of these 17 were varus, 26 valgus, 13 shortening, 14 lengthening and 5 patients had reduced tibial slope. Coronal plane deformities were seen more frequently with eccentric physeal arrest and lengthening with intraepiphyseal tunnelling. Shortening and reduced tibial slope were related to large central physeal arrest and anterior tibial physeal arrest respectively. Extraphyseal technique were least likely to have growth disturbances. 62 studies documented 166 graft failures in 2120 patients (7.83%). Conclusion. Growth disturbances resulting from transphyseal ACL reconstruction can be minimised by keeping drill size small, drilling steep and away from the physeal periphery. Insertion of bone plug, hardware or synthetic material through the drilled physis should be avoided. The evidence to accurately quantify such growth disturbances till skeletal maturity remains weak. Robust long term studies such as national ligament registries may standardise preoperative and postoperative outcome assessment to further characterise the risk of growth disturbance and re-ruptures

Limited long term data exists comparing operatively and non-operatively treated Achilles tendon ruptures. A previous randomised controlled trial comparing early outcomes showed a short term advantage for surgery, but there are no long term prospective randomised comparisons. Our aim was to determine whether surgery conferred long term benefits in terms of patient reported outcomes or re-rupture. 64 patients (80%) were followed up with postal questionnaires. Patients were asked to complete the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS) and EQ-5D questionnaires, and to report re-ruptures. 32 patients were treated non-operatively and 32 operatively; 59 completed the SMFA and 64 the ATRS and EQ-5D assessments. There was no significant difference in SMFA score (median 1.09, IQR 4.89 in the cast group versus 2.17 and 7.07 in the operative group; p=0.347), ATRS (median 96, IQR 18 versus 93 and 15; p=0.509), EQ-5D Index (median 1.0, IQR 0.163 versus 1.0 and 0.257; p=0.327) and EQ-5D Visual Analogue Score (median score 85, IQR 15 versus 85 and 24; p=0.650). There were 2 re-ruptures in the operative group and 4 in the non-operative group (p=0.067). This is the first prospective, randomised, long term report comparing operative and non-operative management. At follow up between 13–17 years after injury, patients reported good function and health related quality of life. There was no significant difference in re-rupture rate between the treatment groups

In January 2000 we introduced identical guidelines for the more rapid rehabilitation of Achilles tendon ruptures, whether treated operatively or non-operatively. A relaxed equinus cast was used to four weeks, then a CAM walker to eight weeks with supervised mobilisation. The aims of this study were to compare the outcomes of the operative and non-operative groups treated with the same rehabilitation program and audit the effectiveness of these guidelines. The audit was retrospective from January 2000 till January 2008. The patients were identified from the Emergency Department admissions database, the hospital clinical coding system, the department’s surgical audit data and the hospital physiotherapy appointment system. The audit system was used to identify patients that had complications of their operative treatment, re-ruptures or readmissions. This study focused on the end points of re-rupture, readmission, complications including wound complications and infection. Five hundred and eighty seven presentations were recorded as Achilles tendon injuries. One hundred and eighty patients were treated operatively and 407 patients were treated conservatively. Seventy five patients (42%) treated operatively and 126 patients (30%) of the non-operative group were rehabilitated in our hospital physiotherapy department. The remaining 386 patients (65.7% of all patients) received physiotherapy elsewhere or did not attend for further treatment. In the operative group there were two re-ruptures (1.1%) both treated in our hospital physiotherapy department. There were 2 wound complications (1.1%), one requiring re-operation. In the non operative group there were 15 re-ruptures (3.7%). Of these three had attended the hospital physiotherapy department (rerupture rate of 2.4%) In the non-operative group treated elsewhere there were 12 re-ruptures from 281 patients (4.2%). Comparable results were found between operative and non-operative treatment when combined with close physiotherapy guidance. Non-operatively treated patients treated in the community may have higher re-rupture rates. The results are comparable to those in the literature suggesting that the guidelines are effective

Traditionally, immobilisation following achilles tendon rupture has been for 10 to 12 weeks. We have previously published a series of 71 consecutive repairs with no re-ruptures, using a lateral surgical approach. The latter part of this cohort were immobilised for six weeks instead of 12, with early weight bearing. The lack of any re-ruptures encouraged us to pursue the accelerated rehabilitation. This study documents a further 34 cases followed prospectively for 6–24 months (mean 15.9 months). All were repaired with a single Kessler-type suture using loop PDS, through a lateral approach. Patients were partial weight-bearing immediately in an Aircast boot with three cork heel wedges. At two-weekly intervals the wedges were reduced, and the boot abandoned after six weeks. There have been no re-ruptures. Thirty of the 34 patients returned to pre-injury activity levels. All patients were satisfied or very satisfied with the immobilisation device and the accelerated rehabilitation regime. Cost savings were also made through use of a single removable orthosis rather than sequential casts. We advocate this regimen of careful operative achilles tendon repair and accelerated weight bearing rehabilitation with a removable orthosis

Traditionally, immobilisation following Achilles tendon rupture has been for 10 to 12 weeks. We have previously published a series of 71 consecutive repairs with no re-ruptures, using a lateral surgical approach. The latter part of this cohort were immobilised for six weeks instead of 12, with early weight bearing. The lack of any re-ruptures encouraged us to persue the accelerated rehabilitation. This study documents a further 34 cases followed prospectively for 6–24 months (mean 15.9 months). All were repaired with a single Kessler-type suture using loop PDS, through a lateral approach. Patients were partial weight-bearing immediately in an Aircast boot with three cork heel wedges. At two-weekly intervals the wedges were reduced, and the boot abandoned after six weeks. There have been no re-ruptures. Thirty of the 34 patients returned to pre-injury activity levels. All patients were satisfied or very satisfied with the immobilisation device and the accelerated rehabilitation regime. Costs savings were also made through use of a single removable orthosis rather than sequential casts. We advocate this regimen of careful operative achilles tendon repair and accelerated weight bearing rehabilitation with a removable orthosis

Introduction: We reviewed the complications and recovery of patients treated for Achilles tendon rupture by percutaneous repair, open repair, and non-operative management in a tertiary referral centre between 2001 and 2003. Materials and Methods: We identified patients who underwent Achilles tendon rupture repair by percutaneous or open methods from the logbooks of Consultants and the operating theatre register. We used plaster room records were also used to identify patients who received non-operative treatment. We collated demographic and management details, and compared them with published rates relating to average age range, demographic, and management details. Results: In the 20 patients who underwent open repair, one (4.8%) patient sustained a re-rupture, four (19%) sustained minor complications, and one (4.8%) had a major complication. In the 31 patients who underwent percutaneous repair, one (3.2%) patient sustained a major complication, six (19.4%) patients experienced minor wound complications, and there were no re-ruptures. In the 12 patients who underwent conservative management, re-ruptures occurred in one patient (8.3%), minor complications occurred in five patients (41.7%), and there were no major complications. The median recovery time in the open, percutaneous and conservative groups was 25 weeks, 26 weeks and 18.5 weeks respectively. Discussion and Conclusion: In our setting, percutaneous repair is the most successful management method, with no re-ruptures and very few complications. Although conservative management produced the highest rate of complications, each patient will have different needs due to their age, occupation or level of sporting activity. Ultimately, the decision of the management regime used probably lies with the patient

Introduction:. Historically the incidence of Achilles re-ruptures has been described as around 5% after surgical repair and up to 21% after conservative management. In 2008 we commenced a dedicated Achilles tendon rupture clinic for both conservative and surgically managed patients using new standardised operating procedures (SOP). We have evaluated the impact of this new service, particularly with regard to re-rupture rate. Materials and methods:. The SOP was stage dependent and included an initial ultrasound examination, functional orthotics with early weight bearing, accelerated exercise and guidelines for the return to work and sport. Evaluation included re-rupture rate, complication rate, and outcome measured by the Achilles Tendon Total Rupture Score (ATRS) and Achilles Tendon Repair Score (AS). A basic cost evaluation was performed to assess any potential savings. Results:. A total of 213 patients (151 treated conservatively and 62 surgically) were included. Re-rupture occurred in two patients (1 conservative and 1 surgically managed). There were 16 major complications e.g. DVT, wound infection. The mean ATRS was 54.79, 67.66 and 71.05 at 4, 6 and 9 months respectively and the mean AS was 64.67, 73.96 and 71.05 at 4, 6 and 9 months respectively. The reduction in re-rupture compared to the literature was 4.1% and 19.1% for surgical and conservatively treated patients respectively. Cost savings achieved were £50,000 each annum. This was due to both a decrease in the number of re-ruptures as well as a decrease in the number of patients being managed operatively. Conclusion:. A dedicated follow up Achilles clinic treating acute Achilles tendon ruptures using monitored SOP's, provides an exceptionally low re-rupture rate (0.9%), excellent patient outcome and potential cost savings compared to a traditional fracture clinic approach. The reduction in re-rupture rate, and therefore cost savings, is greater in conservatively managed patients

Background: 75% of Achilles tendon ruptures are related to physical activities. The best method of treatment for acute Achilles tendon rupture is still debated. Treatment options can be classified as Nonoperative based on cast immobilization, open surgery, and percutaneous surgery based on passing sutures through several stab incisions. Common complications include re-ruptures, infection, wound problems and sural nerve injury. Recent reports of percutaneous surgery show good functional outcome, low incidence of re-ruptures, fewer wound healing problems and prompt recovery. Objective: Assessment of percutaneous operative treatment outcome. Methods: 73 patients treated for acute Achilles tendon rupture with percutaneous surgery in the past eight years are followed. Evaluations were preformed at an average of 34.6 months postoperatively (range, 17 to 54 months). Outcome was evaluated by analyzing Epidemiologic, subjective and objective parameters. Results: The patients demonstrated good functional outcome, with none – to mild limitations in recreational activities. Ankle range of motion was not statistically different between both ankles. Evaluation of strength and power with the Cybex II dynamometer revealed a difference at 240 deg/sec for plantar flexion power between the injured and healthy leg, but no difference at 30 and 90 deg/sec, or in dorsiflexion power and strength. Complication rate was low: sural nerve injury (1 patient), superficial wound infection (2 patients), suture granuloma (4 patients) and re-rupture (1 patient). Conclusions: In our series, percutaneous operative treatment was found to be simple, fast and can be done under local anesthesia. Our low complication rate and excellent functional results make this treatment an appealing alternative to either conservative or open surgical suture

Introduction: Management of acute rupture of the Achilles tendon is controversial. Conservative treatment has a higher re-rupture rate while surgery has complications like infection and wound breakdown. We devised a protocol in our hospital to decide between the surgical or non-surgical options. At our institution, a well-documented and structured program of non-operative or opeartive management of Achilles tendon rupture with use of either casts or operation has been devised based on Ultrasound findings of the ‘Gap/distance between the two ends of the Tear’. PURPOSE: The purpose of this study was to compare the incidence of Re-rupture in those treated by cast immobilization where the ends were approximating at ultrasound examination at our institution. METHODS: This study Prospectively assessed the results in 50 consecutive patients with a complete rupture of the Achilles tendon who had been treated with our regimen depending on the findings of the ultrasound examination, between 2003 and 2006. All ruptured Tendoachilles had ultrasound done in Full Equinus position to assess whether the ends are approximating or not. If ends were approximating they were treated in an equinus cast. Patients were evaluated on the basis of the subjective results and functional outcome measure, along with validated visual analogue scores. Re-rupture rates were measured at 06 months after injury. There were 35 Male and 13 females. This was followed by a final questionnaire to assess their return to pre-injury activities. Two patients were lost to follow-up as they moved out of the area. RESULTS: All the 48 re-ruptures available for analysis had their ultrasound done on initial presentation. 25 were treated non-operatively and 23 underwent surgery. The overall complication rate for Non Operative was minimal, with NO re-rupture or documented deep vein thromboses. In operative group there were 2 re-ruptures, 5 postoperative infection and discharge. CONCLUSION: The results of our non-operative treatment were better overall than published results of non operative & operative repair of acute Achilles tendon rupture. In this study the ends are approximating, confirmed on ultrasound before being assigned to Cast Immobilization. SIGNIFICANCE: The previous studies have not assigned patients into operative or non-operative groups based on whether the ends are approximating in full equines position. By assigning only those in whom the ends are approximating, to cast immobilization, re-rupture rates are less, thus resulting in better and stronger healing of TAs’ and avoiding risks of surgery

Introduction: The treatment of the recently ruptured Achilles tendon is still controversial. Surgical procedures are commonly considered to restore excellent functional capacity and suffer low re-rupture rates, but are potentially associated with significant complications like wound infection and paraesthesia. Recent studies report very good results with a conservative treatment in rigid casts. Our aim was to evaluate a new method of functional and conservative treatment using immobilisation in an articulated cast. Patients and Methods: Between March 1998 and August 2005, 12 women and 45 men with an average age of 45 (24–73), underwent a functional and conservative treatment for a recently ruptured Achilles tendon. After an immobilisation with a cast in equinus for 10 days, the patients were authorised to walk with full weight-bearing, protected by a commercial orthosis (VACO®ped, OPED). The equinus angle was set at 30° plantar flexion until the end of week 3, and at 15° until the end of week 4. At the 5th week the system was unlocked to allow ankle mobilisation of 30-15-0°, and at 30-0-0° at the seventh week. The orthosis was removed after 8 weeks. All patients had follow-up examinations up to 12 months after the trauma. The first 30 patients underwent a clinical examination and muscular testing with a Cybex isokinetic dynamometer at 6 and 12 months. In June 2006 all 57 patients were contacted and received a questionnaire. Their subjective opinions of the outcome, any change in their sport activities and eventual late complications were investigated. We evaluated the questionnaire and medical records using a scoring system based on the Leppilahti Ankle Score. Results: After one year there was not any difference in the motion of the ankle in comparison with the healthy side. There was no substantial calf amyotrophy and we found very little difference in muscular capacity. The average overall satisfaction with the outcome was 8.1 out of 10. We observed 5 complete re-ruptures (9%), 2 partial re-ruptures and 1 deep venous thrombosis complicated by pulmonary embolism. We observed few minor skin complications. Conclusions: The present treatment resulted in good to excellent functional results in most of the cases. It requires an active participation of the patient and a systematic medical follow-up during the first 6 months. The complication rate is acceptable. We think that early ankle mobilisation in the dynamic cast promotes better functional results than a rigid immobilisation technique. There is a place for conservative functional treatment in the acute rupture of the Achilles tendon. But prospective comparison with modern surgical techniques, like minimal invasive suture, is still required, especially in patients with high functional demand

Introduction and Aims: The aims of this study were to compare the over-the-top and four-strand techniques of paediatric anterior cruciate ligament reconstruction. An age and sex-matched control study of these two different ACL reconstructive techniques was done to determine if there are differences in instability, functional outcomes and growth plate-related problems. Method: Injuries, treatment and associated complications were collected from hospital charts. Pre-operative x-rays were used to determine growth plate status both at the distal femur and the proximal tibia. Pre-operative MRIs were studied to assess the position and nature of mid-substance ACL tear and any associated meniscal tear or pathology. Follow-up included examination as per International Knee Documentation Committee guidelines, including patient history and a clinical examination assessing the degree of anterior draw, presence and quality of a pivot shift test and pivot glide, and arthrometric measurements using the KT-1000 Arthrometer for anterior translational distance in millimetres. The Lysholm questionnaire was completed by all patients. Results: Thirty-nine paediatric patients were reviewed for anterior cruciate ligament injuries requiring reconstruction at the authors’ institution. Data collected included background information on the injury, including mechanism and age at injury and surgical information including age at surgery, surgical procedure, and technique. Surgical follow-up information was also collected including wound problems, re-ruptures, or growth arrests. The mean age at injury was 14.3 years. The predominant mechanism of injury was twist and turn with 21 reports. The average age at surgery was 15.2 years, with 20 patients undergoing reconstruction of their ACL alone and 19 patients repair of their ACL and menisci. Fourteen patients were treated using the four-strand technique, while 25 patients were treated using the over-the-top method. We have an average follow-up of 1.9 years post-surgery. Three patients in the over-the-top group had wound infections. There were no known growth arrests or re-ruptures in this patient group based on this limited follow-up. Fifty-five percent of patients had meniscal involvement. Those with a meniscal tear were older than those without (14.5 years versus 11.5 years; p< 0.05). Conclusion: Once rare, injuries of the anterior cruciate ligament in skeletally immature patients have become a common clinical presentation. It is important to have a documentation of the amount of pathologic laxity of the knee joint. Instrumented measurements can show the success of an ACL reconstruction in restoring the patient’s knee to normal joint kinetics

Various arthroscopic techniques using differing graft materials have been described and present a potential alternative to arthroplasty for rotator cuff arthropathy. We describe the short-term outcomes of allograft reconstruction, having evolved of our surgical technique from graft interposition to superior capsule reconstruction (SCR). All patients with an irreparable tear, in the absence of clinical and radiograph evidence of osteoarthritis, who underwent an allograft (Graft Jacket. TM. ) reconstruction with either an arthroscopic interposition or SCR technique within our institution were included. A retrospective case note analysis was performed to ascertain perioperative details including total operating and consumable implant costs. 15 patients were in the interposition group, mean age 66 years (48–77). Mean postoperative follow-up time was 17 months (1.9 −27.8). The mean OSS improved from 30.6 to 35.7 (p<0.05). Additionally, mean pain scores out of 10 improved from 7.7 to 1.5 (p<0.01). Mean satisfaction for the surgery was 7.8 out of 10. Complications included 2 re-ruptures (13.3%), 1 infection (6.7%) and 1 case of no improvement (6.7%). In the SCR group, there were 10 patients, mean age 64.5 (56– 68 years). Half of these patients had previous rotator cuff surgery. Mean postoperative follow-up time was 8.7 months (1.9 – 16.3). The mean OSS improved from 24 to 32.9 (p<0.01). Similarly, pain scores decreased from 7.9 to 3.5 (p<0.01). Mean satisfaction was 7.2. Complications included 1 case of no improvement (10%) resulting in a reverse TSR and 1 re-rupture (10%). A formal, prospective comparison trial is advocated to determine if SCR is superior

Aim. To determine the influence of tendo achilles (TA) rupture gap distance and location on clinical outcome managed with accelerated functional rehabilitation. Methods. Twenty six patients with acute complete TA ruptures underwent ultrasound (US) within a week of injury. Measurements included the distance of the rupture from the enthesis and the gap distance between the tendon edges in three positions –. foot plantigrade,. maximum equinus and. maximum equinus with 90. o. knee flexion. All patients were managed non-operatively in functional weightbearing orthoses. Nineteen patients were followed up at a mean of 6.1 years (range 5.8–6.5). Outcomes included ultrasound confirmation of healing, Achilles Tendon Rupture Score (ATRS) and Modified Lepilahti score (MLS). Results. The mean distance of the rupture from the enthesis was 52mm (range: 40–76mm). The mean gap distance with the foot plantigrade was 11.4mm (95%CI: 9.9, 12.9) which reduced to 4.8mm (95%CI: 3.3, 6.4) in equinus and 1.5mm (95%CI: 0.8, 2.2) with 90° knee flexion. At follow up, no re-ruptures had occurred. US demonstrated continuity in all healed tendons. Mean ATRS was 86 (95%CI: 78.8, 93.9). There was a significant correlation between the distance of the rupture with the MLS (p=0.015) and the ATRS domains of strength (p=0.037) and fatigue (p=0.017). There was no significant correlation between the measured gap distance in the three positions with respect to the MTLS, ATRS or individual ATRS domain scores. There was no significant difference when comparing outcomes between left and right TAs or comparing gaps less than 1cm with those greater than 1 cm. Discussion. The distance of the gap from the enthesis may be more predictive of mid term clinical outcome in patients with TA rupture managed with accelerated functional rehabilitation compared with the magnitude of the gap and extent of closure with equinus and knee flexion

Background. Operative fixation of acute tendo-achilles ruptures remains controversial. Standard surgical exposure is associated with and increased risk of wound breakdown and infections. The mini-open technique was developed to minimise these risks and provide anatomical reduction/apposition of the tendon rupture. Methods. We present a retrospective case series of 27 patients who were treated operatively for acute Achilles tendon rupture in the hands of 1 surgeon, between 4–6 years post operatively, using Achillon instrumentation. Post operatively they were treated with an air cast boot and 3 wedges, bringing the foot into neutral by 6 weeks followed by a rehabilitation programme. The patients were contacted via telephone and consent was obtained. The complications, Leppilahti score and ATRS score were then calculated. Results. 2 patients underwent a further operation (one for a retained suture and another for a re-rupture in an uncompliant patient), in total there were 2 re-ruptures (another patient sustained a partial rupture which was treated conservatively). There were no patients who sustained a wound problem or infection (other than the patient already mentioned). There were 3 patients who complained of ongoing altered sensation in the sural nerve distribution, and 4 who had paraesthesia post operativeley that completely resolved within 3 months. There were no DVT/PE reported and the average Leppilahti score was 85.7/100 (excellent outcome) and ATRS 93.3/100 (excellent outcome). Conclusion. This study shows that the mini-open technique can be used successfully to treat acute tendo-Achilles ruptures with excellent long term outcome