Chou: OKU: Foot and Ankle 7

Chapter 23: Disorders of the Achilles Tendon

located between the tendon stumps. J Bone Joint Surg Am 2016;98(14):1168-1175. 25. Steginsky BD, Van Dyke B, Berlet GC: The missed Achilles tear. Now what? Foot Ankle Clin 2017;22(4):715-734. 26. Maffulli N, Spiezia F, Longo UG, Denaro V: Less-invasive recon struction of chronic Achilles tendon ruptures using a peroneus brevis tendon transfer. Am J Sports Med 2010;38(11):2304-2312. 27. Jeng CL, Thawait GK, Kwon JY, et al: Relative strengths of the calf muscles based on MRI volume measurements. Foot Ankle Int 2012;33(5):394-399. 28. Sarzaeem MM, Lemraski MMB, Safdari F: Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc 2012;20(7):1386-1391. 29. Pavan Kumar A, Shashikiran R, Raghuram C: A novel modifi cation of Bosworth’s technique to repair zone I Achilles tendon ruptures. J Orthop Traumatol 2013;14(1):59-65. 30. Paavola M, Kannus P, Paakkala T, Pasanen M, Järvinen M: Long-term prognosis of patients with Achilles tendinopathy: An observational 8-year follow-up study. Am J Sports Med 2000;28(5):634-642. 31. Gross CE, Hsu AR, Chahal J, Holmes GB Jr: Injectable treat ments for noninsertional Achilles tendinosis: A systematic review. Foot Ankle Int 2013;34(5):619-628. 32. Nauwelaers AK, Van Oost L, Peers K: Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis. Foot Ankle Surg 2021;27(5):486-495. This is a systematic review of literature for platelet-rich plasma treatment of chronic midsubstance Achilles tend inopathy, with four randomized controlled trials meeting the criteria for inclusion in the meta-analysis. Pooled data from 170 patients demonstrated no difference in Victorian Institute of Sports Assessment–Achilles scores for patients undergoing platelet-rich plasma versus saline injection at 3, 6, and 12 months follow-up. No clear improvement in tendon structure among patients who underwent platelet-rich plasma was demonstrated. Level of evidence: I. 33. Al-Abbad H, Simon JV: The effectiveness of extracorporeal shock wave therapy on chronic Achilles tendinopathy: A systematic review. Foot Ankle Int 2013;34(1):33-41. 34. Schon LC, Shores JL, Faro FD, Vora AM, Camire LM, Guyton GP: Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis. J Bone Joint Surg Am 2013;95(1):54-60. 35. Naidu V, Abbassian A, Nielsen D, Uppalapati R, Shetty A: Minimally invasive paratenon release for non-insertional Achilles tendinopathy. Foot Ankle Int 2009;30(7):680-685. 36. Maffulli N, Oliva F, Testa V, Capasso G, Del Buono A: Multiple percutaneous longitudinal tenotomies for chronic Achilles tendinopathy in runners: A long-term study. Am J Sports Med 2013;41(9):2151-2157.

16. Aktas S, Kocaoglu B: Open versus minimal invasive repair with Achillon device. Foot Ankle Int 2009;30(5):391-397. 17. Maffulli N, Longo UG, Maffulli GD, Khanna A, Denaro V: Achilles tendon ruptures in elite athletes. Foot Ankle Int 2011;32(1):9-15. 18. Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB: Clinical outcomes and complications of percutaneous Achilles repair system versus open tech nique for acute Achilles tendon ruptures. Foot Ankle Int 2015;36(11):1279-1286. 19. Jielile J, Sabirhazi G, Chen J, et al: Novel surgical technique and early kinesiotherapy for acute Achilles tendon rupture. Foot Ankle Int 2012;33(12):1119-1127. 20. Maffulli N, Gougoulias N, Maffulli GD, Oliva F, Migliorini F: Slowed-down rehabilitation following percutaneous repair of Achilles tendon rupture. Foot Ankle Int 2022;43(2):244-252. This is a prospective cohort study of 60 patients who under went either traditional accelerated rehabilitation or a slowed-­ down rehabilitation (longer immobilization postoperatively with delay of eccentric exercises to 12 weeks postoperatively), both with immediate weight bearing. The slowed-down reha bilitation group was found to have improved outcomes as measured by Achilles tendon resting angle and Achilles Tendon Total Rupture Score at 12-month follow-up. The slowed-down rehabilitation group was also found to have improved isometric strength and calf circumference that were more similar to those of the contralateral leg. Level of evidence: II. 21. Zellers JA, Pohlig RT, Cortes DH, Grävare Silbernagel K: Achilles tendon cross-sectional area at 12 weeks post-rupture relates to 1-year heel-rise height. Knee Surg Sports Traumatol Arthrosc 2020;28(1):245-252. This is a prospective cohort study of 22 patients with Achilles tendon ruptures, which examined tendon structure (length, cross-sectional area) using ultrasonography as well as func tional outcomes at various time points up to 1 year postin jury. Treatment was not controlled in this study. Both tendon cross-sectional area and length were found to correlate with assessed function, with cross-sectional area at 12 weeks being the greatest predictor of heel rise at 1-year follow-up. Level of evidence: II. 22. Padanilam TG: Chronic Achilles tendon ruptures. Foot Ankle Clin 2009;14(4):711-728. 23. Arshad Z, Lau EJS, Leow SH, Bhatia M: Management of chronic Achilles ruptures: A scoping review. Int Orthop 2021;45(10):2543-2559. This is a systematic review of the literature examining cur rent described techniques and outcomes for treatment of chronic Achilles tendon ruptures. Only one article described nonsurgical management, whereas the remaining articles discussed various surgical approaches with improvement in patient outcomes reported with all techniques. A wide variety of outcomes were reported, however, making comparison between techniques difficult. Level of evidence: III. 24. Yasuda T, Shima H, Mori K, Kizawa M, Neo M: Direct repair of chronic Achilles tendon ruptures using scar tissue

Section 7: Tendon Disorders and Sports Related Foot and Ankle Injuries

37. Kiewiet NJ, Holthusen SM, Bohay DR, Anderson JG: Gastrocnemius recession for chronic noninsertional Achilles tendinopathy. Foot Ankle Int 2013;34(4):481-485. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

369

© 2025 American Academy of Orthopaedic Surgeons

Orthopaedic Knowledge Update ® : Foot and Ankle 7