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Background: Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging due to the difficulty in sensorimotor assessment in pediatric patients. Point-of-care ultrasound (POCUS) has currently been used for identifying tendon injury in adult acute care, but reports of its use in pediatric emergency departments are scarce., Case Report: A previously healthy 14-year-old male patient visited our emergency department due to a finger laceration that occurred when he was cutting sausages using a knife. Physical examination revealed a 1.5 cm laceration over the palmer surface of the left fifth proximal phalanx. Tendon exposure was unremarkable, and the peripheral perfusion and sensation of the injured finger were intact. Flexion of the proximal and distal interphalangeal joints was limited due to pain. POCUS showed the disruption of the tendon structure over the laceration site, suggesting the flexor tendon rupture. Wound exploration by the orthopedic team revealed a transected flexor digitorum superficialis and flexor digitorum profundus and a tendon repair was performed. The patient was discharged with immobilization of the injured hand. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging to diagnose due to the difficulty in sensorimotor assessment in pediatric patients. POCUS can directly visualize a tendon structure without procedural sedation or radiation exposure, empowering physicians to diagnose tendon injuries and optimize patient care., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Treatment outcomes for Achilles tendon ruptures depend upon prompt diagnosis and management. A local study in 2018 highlighted inefficiencies in patient management, and a revised protocol was introduced allowing investigation and referral to be initiated by other healthcare professionals. This retrospective audit evaluates the impact of this on the timescale from presentation to treatment. It analyzes all suspected Achilles tendon ruptures within one District General Hospital from April 2021 to March 2022. Data regarding patient timelines was compared to the 2018 study. Over 12 months, 99 patients were referred to Virtual Fracture Clinic, 87.8% (n = 87) of which had a complete or partial tear on ultrasound scan (USS). In comparison to 2018, the average time from presentation to USS request reduced from 2.9 to 1.1 days (p < .01). 95% were scanned within one week of USS request and 31.3% within 48 hours (81% and 18%, previously). The average time from USS request to scan went from 6.8 to 3.2 days (p < .01). The time from presentation to treatment decision reduced from 10.9 to 6.2 days (p < .01) and the percentage of patients with a definitive treatment plan within one week increased from 34.5% to 74.2% (p < .01). Patients required 0.8 fewer appointments (p < .01) giving an estimated total saving of $10,110 ($128 per patient) during the analyzed period. The Achilles Tendon Rupture Pathway has significantly improved the proportion of patients undergoing USS within 48 hours and receiving a treatment decision within one week. This study demonstrates an efficient, cost-saving and replicable pathway for Achilles tendon ruptures., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Purpose: Lesions of the peroneal tendons are frequently overseen after ankle sprain. The symptoms consist of stress-dependent pain that extends from the inframalleolar to the proximal part along the course of the peroneal tendons as well as ankle instability and soft-tissue swelling. In case of unsuccessful conservative treatment, surgical therapy is recommended. The aim of the study was to evaluate the clinical and functional outcome after open reconstruction of the peroneus brevis tendon., Methods: 13 patients were included in this retrospective study. All of them received a single reconstruction of the peroneus brevis tendon in open technique. Postoperative results were evaluated with the AOFAS score, a functional and perdobargraphic analysis as well as measuring postural stability with the Biodex balance system. The participants were matched with a healthy control group according to age, sex and BMI., Results: The results of the AOFAS score showed significantly convincing results in all subscores postoperatively. A bilateral comparison of the postural stability showed that the affected side had become functionally similar to the healthy side. No statistical significant difference was detected concerning both one-legged and two-legged standing with the control group. Pedobarographic results revealed no difference between the affected and contralateral side, as well as between the patients and the healthy control group., Conclusion: Open reconstruction of the peroneus brevis tendon leads to significant better postoperative results and can be recommended after unsuccessful conservative treatment as promising option., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

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

With up to 50 incidents per 100,000 inhabitants, Achilles tendon ruptures are among the most frequent tendon injuries encountered in orthopedics and trauma surgery. Apart from high-risk forms of sport, degenerative processes are primarily responsible for weakening and ultimately rupture. In addition to assessing the typical clinical signs with inability to perform powerful plantar flexion, the diagnostics include easy to earn examination techniques, such as the Thompson test and ultrasound as the imaging gold standard. Conservative and surgical treatment are available depending on the constitution, age and requirements of the patient. The latter option is divided into conventional open, minimally invasive or percutaneous procedures. Good to very good results can be expected regardless of the form of treatment, provided that early functional rehabilitation is carried out. The average rerupture rate is 5% and the return to sport rate is around 80%., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The long head of the biceps (LHB) tendon is a common source of shoulder pain. Often associated with other injuries, the tendon can alone be responsible of the symptoms. Spontaneous rupture has been observed to allow for pain relief. The spectrum of LHB lesions is broad. Repetitive motion, carrying heavy loads, have been associated with diagnosis. Specific tests have been described to diagnose biceps injuries, their implementation can remain difficult in the presence of associated pathologies. The combination of a history and clinical examination with the use of targeted imaging is required to establish the diagnosis. The management of bicipital pathologies is frequently carried out following main surgical procedures. Isolated management of biceps lesions can provide a satisfactory result when a comprehensive procedure cannot be performed., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The complete loss of finger extension leads to significant inconvenience in daily life and often requires surgical treatment. Despite some disadvantages, the Boyes method, which uses the flexor digitorum superficialis tendon, is commonly performed for complete extensor rupture. We report the case of a 73-year-old woman living alone diagnosed with a subcutaneous rupture of all extensor tendons from the index to the little finger. The favourable range of motion of her wrist allowed us to perform extensor tenodesis. Additionally, the patient had a dislocated thumb interphalangeal (IP) joint, enabling us to use the extensor pollicis longus tendon for tendon transfer in combination with thumb IP joint fusion. The patient demonstrated favourable finger range-of-motion outcomes at the 6-month postoperative assessment. The case shows that extensor pollicis longus tendon transfer and tenodesis may be a viable treatment option for patients with complete extensor rupture accompanied by thumb IP joint deformity and normal wrist range of motion., (© Japan College of Rheumatology 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Purpose: The purpose of the study was to evaluate how the initial diagnostic tool used-specifically ultrasound (US) or magnetic resonance imaging (MRI)-for diagnosing proximal hamstring avulsion injury affects the delay before surgery and, secondarily, the outcomes of these injuries., Methods: This was a retrospective analysis of prospectively collected data (2012-2020). It targeted patients primarily treated for proximal hamstring avulsion injury. It included all patients with a preoperative US and/or MRI. Patients were divided into two groups based on the initial diagnostic tool used (US-first vs. MRI-first groups). The primary outcomes measure was the time from initial injury to surgical intervention (surgical delay). The secondary outcomes were the Parisien Hamstring Avulsion Score, as well as the activity level as measured by the University of California, Los Angeles (UCLA) Activity Scale and Tegner Activity Scale., Results: The analysis included 392 patients with a mean age of 43.8 ± 13.6 years for the MRI-first group and 47.6 ± 12.0 years for US-first group. Patients in the MRI-first group had a significantly shorter median time from injury to surgery of 20.0 days (interquartile range [IQR]: 11.0-61.0) compared to 30 days (IQR: 18-74) in the US-first group. At the final follow-up (4.2 ± 2.2 years for the MRI-first group and 5.1 ± 1.9 years for the US-first group), the MRI-first group had significantly higher mean Tegner Activity Scale and UCLA scores than the US-first group: The Tegner Activity Scale was median 5 (IQR: 3-7) for the MRI-first group versus median 4 (IQR: 2-6) for the US-first group (p < 0.05). The UCLA scores were 7.9 ± 2.4 for the MRI-first group compared to 7.3 ± 2.4 for the US-first group (p < 0.05). This difference was more pronounced when comparing the MRI-first group with the patient-false negative initial ultrasound. No difference was found regarding the Parisien Hamstring Avulsion Score., Conclusion: MRI as the initial diagnostic tool for proximal hamstring avulsion injury is associated with a shorter time to surgery and better postoperative outcomes in Tegner Activity Scale and UCLA scores, compared to US., Level of Evidence: Level III., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Pathologic abnormality of the peroneal tendons are thought to be an under-appreciated source of vague ankle and hindfoot pain in paediatric patients, partly because they can be difficult to diagnose and differentiate from lateral ankle ligament injuries. While magnetic resonance imaging (MRI) is the primary imaging modality used to detect peroneal tendon pathology, previous studies in adults have found that positive MRIs demonstrate a positive predictive value (PPV) of associated clinical findings around 48%. There are no similar known published studies in the paediatric population. Our objective was to determine the positive predictive value of peroneal tendon pathology as diagnosed by MRI as related to positive clinical exam findings in the paediatric and adolescent population., Methods: This IRB approved retrospective study was conducted at a tertiary children's hospital. Inclusion criteria included patients under 18 years from our tertiary care institution with (a) ankle MRI findings indicating pathology of the peroneus brevis/longus tendons confirmed by a board certified paediatric musculoskeletal radiologist and (b) formal review of the clinical examination by a fellowship trained paediatric orthopaedic surgeon. Patients with congenital deformities or previous surgical intervention of the lateral ankle were excluded., Results: Forty-seven patients (with 48 MRIs) met inclusion criteria over a ten year period. The majority of the positive MRI scans (70%) demonstrated a peroneus brevis split tear. Of the patients with positive findings on MRI, 17 patients had an associated positive clinical exam. The positive predictive value of MRI for peroneal tendon tears with positive clinical findings was 35.41% (95% confidence interval = 31.1% to 41.6%). There were 31 patients with MRI positive findings with a negative clinical exam., Conclusion: Despite having a negative clinical exam, a high percentage of patients had positive MRI findings suggestive of peroneal tendon pathology which confirms findings of adult populations demonstrating a high rate of incidental finding of peroneal tendon pathology on MRI in paediatric patients., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Abstract: A 72-year-old male presented for evaluation of a 2-wk history left buttock pain that began while playing pickleball. He sustained a left inversion ankle sprain while in a squatted position and landed on his left buttock. Four days after his injury, he developed extensive bruising involving his lower back, buttock, and left thigh. On examination, he had tenderness to palpation at the left side of the sacrum and in the region of the deep external rotators. Left hip range of motion was full in extension but limited to 90° of flexion, which reproduced left-sided buttock pain. External rotation provoked pain, but internal rotation was full and pain free. MRI of the pelvis demonstrated a grade 2 partial thickness tear of the left gluteus maximus muscle at its distal myotendinous junction with associated retraction and intramuscular hematoma. He was managed with compression with biking shorts, icing, acetaminophen, and physical therapy. He returned to pickleball approximately 4 wk after his injury, and at his 4-wk follow-up, he reported 99% improvement in his symptoms with the only remaining complaint being minimal discomfort with gluteal stretching., (Copyright © 2024 by the American College of Sports Medicine.)

We present a case of a fit man in his 50s, with simultaneous bilateral quadriceps tendon repair of injuries sustained 6 years apart. Spontaneous closed ruptures of the quadriceps tendon are uncommon. Clinical data of a single case of bilateral quadriceps tendon injury with simultaneous repair was gathered via the patient, notes and surgeon. Diagnosis was primarily based on history and clinical examination. Suggestive features on the plain radiographic imaging were also present. Confirmation was attempted using ultrasonography but yielded conflicting reports. The patient was screened for any associated predisposing conditions that would preclude surgical intervention or increase risk of recurrence. Repairs were accomplished by employing a combination of suture anchors and transpatellar cerclage reinforcement. Apposition of the tendon to the superior patellar pole was successful although with decreased passive flexion on the neglected side (approximately 30°) compared with the acute (approximately 90°). Follow-up continues with postoperative rehabilitation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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., (© 2024. The Author(s).)

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., (© 2024 Wiley Periodicals LLC.)

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., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: O.A.O. has received support for education from Medwest Associates. J.C. has received consulting fees from Arthrex, CONMED Linvatec, Ossur, Smith & Nephew, DePuy Synthes Products, and Vericel and hospitality payments from Stryker and Medical Device Business Services. S.J.N. has received research support from Allosource, Arthrex, Athletico, DJ Orthopedics, Linvatec, Miomed, Smith & Nephew, and Stryker; consulting fees from Stryker and Ossur; IP royalties from Ossur and Stryker; and publishing royalties and consulting fees from Springer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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., (© 2024. The Author(s).)

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., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose of the Study: The aim of this study is to describe injury patterns, characteristics, treatment modalities and functional outcomes after punching related injuries., Material and Methods: Retrospective data of cases admitted to emergency department following punch injury between January 1, 2012, and December 31, 2022. was collected. Patient's demographic data, the dominant and injured upper extremity side, punched object, a time of patient admission were recorded. Smoking habit and blood ethanol level were documented. Trauma mechanism, diagnosis (1: dermabrasions: skin, 2: lacerations: neurovascular structures or tendons and 3: osseous pathologies), treatment modalities were analyzed. Outcomes were assessed using the DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand) at the last follow-up., Results: A total of 1052 patients (male=968 (92%), female=84 (8%)) with mean age 24.6 ± 7.2 included this study. Six hundred and twenty-one (59%) patients punched a solid object and 675 (64%) had osseous pathology. The most commonly fractured bone, injured tendon, injured nerve, and injured artery were 5th metacarpal, extensor digitorum communis (EDC), ulnar nerve, and ulnar artery, respectively. The majority of the patients, (73%) were smokers while 15% of the patients had high level of blood ethanol concentration on admission (82±12.3 mg/100 ml). A comparison between smokers and non-smokers did not reveal any significant differences (p=0.425) in terms of diagnosis whereas 74% of alcoholic patients admitted with lacerations which was statistically significant (p=0.023). Injuries of 321 (30.5%) patients required surgery in the operating room, while 711(67.5 %) patients received interventions in the emergency room setting. The average DASH score differed between subgroups, with significantly higher scores in patients with laceration type injuries (7.2 SD), indicating more disability (p=0.001) DISCUSSION. The study reveales a high prevalence of hand injuries among individuals aged 18 to 40, with the dominant hand being most affected, primarily due to physical violence and self-harming behaviors. Primary contributing factors to this pattern are the escalated incidents of physical violence and self-harming behaviors arising from an inability to manage anger impulses. Punching solid objects, especially during late afternoon and evening periods often associated with alcohol use, was a common cause, resulting in metacarpal fractures being the most reported injury. Multiple tendon and nerve injuries were frequent, highlighting the severity and complexity of these traumas, often necessitating surgical intervention., Conclusions: These findings highlight the several key aspects, including demographic characteristics of the patient population, common causes and types of injuries observed, and the association between alcohol use as well as the specific injury profiles. Satisfactory results can be achieved with both conservative and surgical treatment for punch injuries., Key Words: punching, fisting, boxing injuries, laceration, blood ethanol level.

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., (© 2023. The Author(s).)

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., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

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., (© 2023 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

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., (© 2023. The Author(s).)

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.

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; I 2 =46%), autograft repair through semitendinosus/gracilis/ plantaris/ Achilles tendon/ peroneus longus ([OR] 4.14; I 2 =71%), or direct repair ([OR] 3.59; I 2 =57%), provided the best postoperative outcomes, whereas allograft repair ([OR] .52; I 2 =77%),and ipsilateral split/ turn-down tibialis anterior tendon ([OR] .69; I 2 =71%), were associated with poorer outcomes. Ruptures fixed in the acute phase ([OR] 8.3; I 2 =26%), were associated with statistically significant better outcomes when compared to these ruptures fixed in the chronic phase ([OR] .52; I 2 =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., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

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., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

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., (Copyright © 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

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., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

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)., (© 2023. The Author(s).)

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., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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).

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., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B978)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Introduction: Prior studies of hamstring tendon tears have reported varied findings on whether increased delay from injury to surgery is associated with worse outcomes. The purpose of this study was to determine whether increased time from injury to surgical repair is associated with worse clinical outcomes in patients with proximal hamstring ruptures., Materials and Methods: Patients who underwent surgical repair of a proximal hamstring rupture from 2010 to 2019 were followed for a minimum of 24 months from surgery. A cutoff of 6 weeks from injury to the time of surgery was used to distinguish between acute and chronic ruptures. All patients completed patient-reported outcome measures (PROs) at the final follow-up. Multiple factors were analyzed for their effects on PROs including time to surgery, amount of tendon retraction, and demographics such as sex and age., Results: Complete data sets were obtained for 38 patients at a mean follow-up of 4.9 years. All data is reported as a mean ± standard deviation. Patients who underwent acute repair of proximal hamstring ruptures had significantly greater Perth Hamstring Assessment Tool (PHAT) scores than those who underwent chronic repair (76.9 ± 18.8 vs 60.6 ± 18.2, p = 0.01). Increased time to surgery was significantly correlated with worse PHAT scores (ρ = - 0.47, p = 0.003). There was no difference in PROs based on the amount of tendon retraction, number of tendons torn, sex, smoking status, or BMI., Conclusions: This study found that acute repair performed within 6 weeks of injury appears to yield improved PROs compared to chronic repair. These data highlight the importance of timely and accurate diagnosis of proximal hamstring ruptures and early operative intervention for surgical candidates., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Peroneal subluxation is a rare but debilitating pathology that can be the result of a superior peroneal retinaculum tear or intrasheath laxity. On clinical examination of both cases, the pathology is observed when the ankle is circumducted in eversion and dorsiflexion. With a superior peroneal retinaculum tear, the tendons dislocate from the peroneal groove, whereas with intrasheath laxity the tendons remain in the groove. In the present case series, peroneal stabilization was performed for both superior peroneal retinaculum tear and intrasheath laxity. With our technique, the fibro-osseous connections of the peroneal tendon sheath are detached from the distal one third of the fibula. Drill holes are made through the fibula for suture to be passed through and the peroneal tendon sheath is reattached to the fibula through horizontal mattress sutures via pants over vest technique to restore tension to the sheath. A total of 5 patients underwent peroneal stabilization, 100% (5/5) of which had preoperative pain with palpation along the peroneal tendons and a palpable click with range of motion of the ankle joint. Postoperatively, 100% (5/5) of the patients were fully weight-bearing, compared to 60% (3/5) preoperatively. No patients had residual subluxation of the peroneal tendons postoperatively or a need for revisional surgery. Residual peroneal tendonitis was present in 20% (1/5) of patients and sural neuritis occurred in 20% (1/5) of patients. The peroneal tendons are physiologically tightened within the peroneal tendon sheath to mitigate the pathologic subluxation, without sacrificing tendons for transfer or using allograft material. Clinical Level of Evidence : Therapeutic, Case Series, Level 4.

Background: Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its clinical efficacy for acute Achilles tendon rupture are limited. We performed a systematic review and meta-analysis to investigate this and to compare to those without PRP treatment., Methods: The Cochrane Controlled Register of Trials, Pubmed, Medline and Embase were used and assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ('plasma' OR 'platelet-rich' OR 'platelet-rich plasma' or 'PRP') AND ('Achilles tendon rupture/tear' OR 'calcaneal tendon rupture/tear' OR 'tendo calcaneus rupture/tear'). Data pertaining to biomechanical outcomes (heel endurance test, isokinetic strength, calf-circumference and range of motion), patient-reported outcome measures (PROMs) and incidence of re-ruptures were extracted. Meta-analysis was performed for same outcomes measured in at least three studies. Pooled outcome data were analysed by random- and fixed-effects models., Results: After abstract and full-text screening, 6 studies were included. In total there were 510 patients of which 256 had local PRP injection and 254 without. The average age was 41.6 years, mean time from injury to treatment 5.9 days and mean follow-up at 61 weeks. Biomechanically, there was similar heel endurance, isokinetic strength, calf circumference and range of motion between both groups. In general, there were no differences in patient reported outcomes from all scoring systems used in the studies. Both groups returned to their pre-injured level at a similar time and there were no differences on the incidence of re-rupture (OR 1.13, 95% CI, 0.46-2.80, p = 0.79)., Conclusion: PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes. However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)

Introduction: Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is hip abductor tendon (HAT) tears. Traditionally, these patients have been managed non-operatively, often with temporary pain relief. More recently, there has been an increase in published work presenting the results of surgical intervention. A variety of open and endoscopic transtendinous, transosseous and/or bone anchored suture surgical techniques have been reported, with and without the use of tendon augmentation for repair reinforcement. While patient outcomes have demonstrated improvements in pain, symptoms and function, post-operative rehabilitation guidelines are often vague and underreported, providing no guidance to therapists., Materials and Methods: A systematic search of the literature was initially undertaken to identify published clinical studies on patients undergoing HAT repair, over a 3-year period up until May 2020. Following the application of strict inclusion and exclusion criteria, studies were identified and the detail relevant to rehabilitation was synthesized and presented. Published detail was combined with the authors clinical experience, with a detailed overview of rehabilitation proposed for this patient cohort., Results: A total of 17 studies were included, reporting varied detail on components of rehabilitation including post-operative weight bearing (WB) restrictions, the initiation of passive/active hip range of motion (ROM) and resistance exercises. A detailed rehabilitation guide is proposed., Conclusion: In combining the current published literature on rehabilitation after HAT repair and our own clinical experience in the surgical management and post-operative rehabilitation of these patients, we present an evidence-based, structured rehabilitation protocol to better assist surgeons and therapists in treating these patients. This rehabilitation protocol has been implemented for several years through our institutions with encouraging published clinical outcomes., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Objective: Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been written on the topic, no actual consensus exists on the best treatment. We aimed to collect the highest quality of evidence on the subject and to produce a document to which to refer, from the diagnosis to the final treatment. Material and Methods: Inclusion criteria were systematic reviews discussing Achilles tendon rupture, concerning either diagnostic criteria, classification, or treatment; English language; clearly stated inclusion and exclusion criteria for patients' selection. Results: Thirteen systematic reviews were included in the study. A strong consensus exists about the higher risk of re-rupture associated with non-operative treatment and a higher risk of complications associated with surgical repair. Conclusions: The combination of minimally invasive repair and accelerated functional rehabilitation seems to offer the best results in the treatment of Achilles tendon rupture.

Diagnosis and Therapy of Acute Achilles Tendon Ruptures Abstract. Acute Achilles tendon ruptures are a common pathology and often affect young athletic patients. Diagnosis is mostly clinical and by ultrasound. Conservative and operative treatment algorithms exist. The result of the treatment is mostly influenced by the elongation of the tendon during healing. Operative procedures tend to lead to less elongation but have a complication risk. After-treatment should be functional to reduce complication rate and faster rehabilitation. Treatment results are good in general, but some weakness is often found on the injured side.

Among lesions of the rotator cuff, subscapularis tendon tears are one of the less common injuries and mostly occur in combination with additional lesions of the posterosuperior rotator cuff and the long biceps tendon. If a subscapularis tendon rupture is suspected in the initial clinical testing, the primary diagnostics should include modern cross-sectional magnetic resonance imaging to assess the tendon lesion and to detect concomitant pathologies. Nevertheless, subscapularis tendon lesions are often initially overlooked and first correctly diagnosed during shoulder arthroscopy., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8 weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 31 0 (range 3°-59 0 ) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40 years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 13 0 (range 0°-40 0 ). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Case: Herein is presented a case of rupture of the A2/A3 annular pulleys of the left second toe in a 33-year-old male patient after a snowboarding injury. The injury was detected on magnetic resonance imaging (MRI) 7 weeks after the initial trauma. The patient was treated conservatively, including toe splinting, with the patient returning to his asymptomatic preinjury baseline after 6 months., Conclusion: Annular pulley rupture of the toes is a novel cause of prolonged forefoot pain. Clinician awareness of this unique injury and its often subtle MRI findings may help avoid delays in appropriate diagnosis and treatment., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B899)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: The optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures., Methodology: This study was done at East Kent Hospital University Foundation Trust in between 2019-2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score., Result: Our study population was predominantly male with an average age of 50 (range 22-79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions., Conclusion: Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome., (Copyright © 2021 European Foot and Ankle Society. All rights reserved.)

Introduction: Hand lacerations are common injuries seen by the primary care physician. Even seemingly small cuts carry a high risk of injury to flexor tendons of the hand which requires surgical treatment by a specialist. Elucidation of the relevant history, along with a dedicated and focused physical examination is imperative for an early intervention which, along with a meticulous surgical technique and dedicated rehabilitation by occupational therapists, will lead to a much improved functional prognosis for the patient. This is a brief review of the anatomy and physiology of flexor tendons injury and repair, with historical milestones of developments in the approach to the injury. The article also highlights the surgical procedure brought forth by the late Professor Isidor Kessler, one of the founders of surgery of the hand in Israel, presented here as an overview and guidance to the primary care physician.

Background: Distal biceps tendon ruptures can lead to significant restrictions in affected patients. The mechanisms of injury described in scientific literature are based exclusively on case reports and theoretical models. This study aimed to determine the position of the upper extremities and forces involved in tendon rupture through analyzing video recordings., Methods: The public YouTube.com database was queried for videos capturing a clear view of a distal biceps tendon rupture. Two orthopedic surgeons independently assessed the videos for the activity that led to the rupture, the arm position at the time of injury and the forces imposed on the elbow joint., Results: Fifty-six video segments of a distal biceps rupture were included (55 male). In 96.4%, the distal biceps tendon ruptured with the forearm supinated and the elbow isometrically extended (non-dynamic muscle engagement) (71.4%) or slightly flexed (24%). The most common shoulder positions were adduction (85.7%) and neutral position with respect to rotation (92.9%). Most frequently a tensile force was enacted on the elbow (92.9%) and the most common activity observed was deadlifting (71.4%)., Conclusion: Distal biceps tendon ruptures were most commonly observed in weightlifting with a slightly flexed or isometrically extended elbow and forearm supination. These observations may provide useful information for sports specific evidence-based injury prevention, particularly in high performing athletes and individuals engaged in resistance training., Level of Evidence: Observational study., (© 2022. The Author(s).)

Background: Delayed treatment of Achilles tendon ruptures is generally due to either misdiagnosis or patient delay. When the treatment is delayed more than 4 weeks, the rupture is defined as "chronic", and almost always requires more invasive surgery and longer rehabilitation time compared with acute Achilles tendon ruptures. There is insufficient knowledge of patient experiences of sustaining and recovering from a chronic Achilles tendon rupture., Methods: To evaluate patients' experiences of suffering a chronic Achilles tendon rupture, semi-structured group interviews were conducted 4-6 years after surgical treatment using a semi-structured interview guide. The data were analyzed using qualitative content analysis described by Graneheim and Lundman., Results: The experiences of ten patients (65 ± 14 years, 7 males and 3 females) were summarized into four main categories: (1) "The injury", where the patients described immediate functional impairments, following either traumatic or non-traumatic injury mechanisms that were misinterpreted by themselves or the health-care system; (2) "The diagnosis", where the patients expressed relief in receiving the diagnosis, but also disappointment and/or frustration related to the prior misdiagnosis and delay; (3) "The treatment", where the patients expressed high expectations, consistent satisfaction with the surgical treatment, and addressed the importance of the physical therapist having the right expertise; and (4) "The outcomes", where the patients expressed an overall satisfaction with the long-term outcome and no obvious limitations in physical activity, although some fear of re-injury emerged., Conclusions: An Achilles tendon rupture can occur during both major and minor trauma and be misinterpreted by both the assessing health-care professional as well as the patient themselves. Surgical treatment and postoperative rehabilitation for chronic Achilles tendon rupture results in overall patient satisfaction in terms of the long-term outcomes. We emphasize the need for increased awareness of the occurrence of Achilles tendon rupture in patients with an atypical patient history., (© 2022. The Author(s).)

Acute bilateral quadriceps tendon rupture is a musculoskeletal injury that requires urgent orthopedic surgical evaluation. Bilateral quadriceps tendon rupture is exceptionally rare, yet a missed diagnosis can result in long-term disability for the patient. This article presents a patient's case including the history, physical examination, key imaging findings, and management. This article emphasizes the importance of a detailed physical examination in patients presenting with musculoskeletal complaints as well as maintaining a broad differential diagnosis, which will assist the advanced practice provider in recognizing both the common and rare diagnoses in the emergency department., Competing Interests: Disclosure: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)