{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T12:11:04Z","timestamp":1775391064716,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A web\u2010based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A \u2018main tendency\u2019 was considered when 75% of the participants chose the same treatment method, a \u2018tendency\u2019 for 50%\u201375%, and \u2018no tendency\u2019 when less than 50% choose the same method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End\u2010to\u2010end repair for defects &lt;2\u2009cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight\u2010bearing (90%), and physiotherapy initiation at 4\u20136 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study confirms significant variation in CATR management internationally. While end\u2010to\u2010end repair is a consistent choice for gaps smaller than 2\u2009cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70327","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T13:20:09Z","timestamp":1770384009000},"page":"1452-1463","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0119-4479","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Vide","sequence":"first","affiliation":[{"name":"Hospital da Luz Lisboa Lisbon Portugal"},{"name":"Hospital Particular do Algarve Faro Portugal"},{"name":"Faculdade de Medicina \u2013 Universidade de Lisboa Lisbon Portugal"},{"name":"Cat\u00f3lica Medical School Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Santos","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina \u2013 Universidade de Lisboa Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Dantas","sequence":"additional","affiliation":[{"name":"Hospital do Litoral Alentejano Sines Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuel","family":"Sei\u00e7a","sequence":"additional","affiliation":[{"name":"Hospital da Luz 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Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Guelfi","sequence":"additional","affiliation":[{"name":"Casa di Cura Villa Montallegro Genoa Italy"},{"name":"J Medical Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Choon Chiet","family":"Hong","sequence":"additional","affiliation":[{"name":"National University Hospital Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pim","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Academic University Medical Center, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"Spennacchio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Centre Hospitalier de Luxembourg Luxembourg City Luxembourg"},{"name":"Luxembourg Institute of Research in Orthopaedics Sports Medicine and Science (LIROMS) Luxembourg City Luxembourg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillaume","family":"Cordier","sequence":"additional","affiliation":[{"name":"Clinique du Sport Vivalto Sant\u00e9 Bordeaux Merignac France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niek","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Academic University Medical Center, University of Amsterdam Amsterdam The Netherlands"},{"name":"Ripoll\u2010DePrado Sport Clinic Madrid Spain"},{"name":"Cl\u00ednica do Drag\u00e3o Porto Porto Portugal"},{"name":"Casa di Cura San Rossore Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Ling","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital, The Chinese University of Hong Kong \u2010 Hong Kong  China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinghui","family":"Hua","sequence":"additional","affiliation":[{"name":"Huashan Hospital, Fudan University 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