{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:21:11Z","timestamp":1783657271339,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Achilles tendon ruptures (ATR) result in loss of strength and function of the gastrosoleus\u2014Achilles tendon complex, probably because of gradual tendon elongation and calf muscle atrophy, even after surgical repair. Flexor hallucis longus (FHL) augmentation not only reinforces the repair and provides new blood supply to the tendon, but also protects the repair, internally splinting the repaired Achilles tendon, maintaining optimal tension. We prospectively compared the clinical outcomes of patients with acute ATR, managed with either percutaneous repair only or percutaneous repair and FHL augmentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with acute ATR undergoing operative management were divided into two groups. Thirty patients underwent percutaneous repair under local anesthesia, and 32 patients underwent percutaneous repair augmented by FHL tendon, harvested through a 3\u00a0cm longitudinal posteromedial incision, and transferred to the calcaneus, under epidural anesthesia. All patients were treated by a single surgeon between 2015 and 2019 and were followed prospectively for 24\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The percutaneous only group was younger than the augmented one (35.4\u2009\u00b1\u20098.0 vs 40.4\u2009\u00b1\u20096.6 years, <jats:italic>p<\/jats:italic>\u2009=\u20090.01)<jats:italic>.<\/jats:italic> In the augmented group, 25 patients stayed overnight and only 5 were day cases, whereas in the percutaneous only group 4 patients stayed overnight and 28 of them were day cases (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The duration of the procedure was significantly longer in the augmented group (38.9\u2009\u00b1\u20095.2 vs 13.2\u2009\u00b1\u20092.2\u00a0min, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). At 24\u00a0months after repair, the Achilles tendon resting angle (ATRA) was better in the augmented group (\u22120.5\u2009\u00b1\u20091.7 vs \u22124.0\u2009\u00b1\u20092.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), as was Achilles tendon rupture score (ATRS) (91.7\u2009\u00b1\u20092.2 vs 89.9\u2009\u00b1\u20092.4, <jats:italic>p<\/jats:italic>\u2009=\u20090.004). Calf circumference of the injured and the non\u2010injured leg did not differ between the groups, as did the time interval to single toe raise and the time interval to walking in tiptoes. Although plantarflexion strength of the operated leg was significantly weaker than the non\u2010operated leg in both groups, the difference in isometric strength of the operated leg between the groups was not significant at 24\u00a0months (435\u2009\u00b1\u200937.9 vs 436\u2009\u00b1\u200939.7\u00a0N, n.s.).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Percutaneous repair and FHL tendon augmentation may have a place in the management of acute Achilles tendon ruptures, reducing tendon elongation and improving functional outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level II.\n<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-07183-0","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T09:09:27Z","timestamp":1665997767000},"page":"94-101","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Primary augmentation of percutaneous repair with flexor hallucis longus tendon for Achilles tendon ruptures reduces tendon elongation and may improve functional outcome"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5327-3702","authenticated-orcid":false,"given":"Nicola","family":"Maffulli","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Medicine, Surgery and Dentistry University of Salerno Via S. Allende 84081 Baronissi SA Italy"},{"name":"<!--<label>2<\/label>--> School of Pharmacy and Bioengineering Keele University School of Medicine Thornburrow Drive Stoke on Trent England, UK"},{"name":"<!--<label>3<\/label>--> Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine Queen Mary University of London, Mile End Hospital 275 Bancroft Road E1 4DG London England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Gougoulias","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopedic Surgery General Hospital of Katerini Katerini Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Christidis","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopedic Surgery General Hospital of Katerini Katerini Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayle D.","family":"Maffulli","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Wholelife Clinics London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Oliva","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Medicine, Surgery and Dentistry University of Salerno Via S. Allende 84081 Baronissi SA Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007211036439"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010021\u201005102\u20105"},{"key":"e_1_2_9_4_2","doi-asserted-by":"crossref","unstructured":"AttiaAK KhamisKM DhoogheP BariteauJT LabibSA MyersonMSOutcomes and complications of open vs minimally invasive surgical repair of acute Achilles tendon rupture: a systematic review and meta\u2010analysis of randomized controlled trials.Foot Ankle Orthop(2022)10.1177\/03635465211053619","DOI":"10.1177\/2473011421S00095"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2019.12.008"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos\u20102019\u2010000395"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmart.2014.12.002"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010007\u20100411\u2010z"},{"key":"e_1_2_9_9_2","doi-asserted-by":"crossref","unstructured":"CarmontMR SilbernagelKG EdgeA Mei\u2010DanO KarlssonJ MaffulliNFunctional outcome of percutaneous Achilles repair: improvements in Achilles tendon total rupture score during the first year.Orthop J Sport Med(2013)10.1177\/2325967113494584","DOI":"10.1177\/2325967113494584"},{"key":"e_1_2_9_10_2","doi-asserted-by":"crossref","unstructured":"DinizP FerreiraAS FigueiredoL BatistaJP AbdelatifN PereiraH KerkhoffsGMMJ FinkelsteinSN FerreiraFCEarly analysis shows that endoscopic flexor hallucis longus transfer has a promising cost\u2010effectiveness profile in the treatment of acute Achilles tendon ruptures.Knee Surg Sports Traumatol Arthrosc(2022)10.1007\/s00167\u2010022\u201007146\u20105","DOI":"10.1007\/s00167-022-07146-5"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518781826"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.01364"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.01491"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010022\u201007142\u20109"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.100B5.BJJ\u20102017\u20101053.R1"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0000000000000086"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512473819"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520908592"},{"key":"e_1_2_9_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007211038594"},{"key":"e_1_2_9_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2017.02.002"},{"key":"e_1_2_9_21_2","doi-asserted-by":"crossref","unstructured":"MaffulliN PerettiGMSurgery or conservative management for Achilles tendon rupture?.BMJ(2019)10.1136\/bmj.k5344","DOI":"10.1136\/bmj.k5344"},{"key":"e_1_2_9_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)33133\u20102"},{"key":"e_1_2_9_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000001861"},{"key":"e_1_2_9_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.15.1987"},{"key":"e_1_2_9_25_2","doi-asserted-by":"crossref","unstructured":"OchenY BeksRB Van HeijlM HietbrinkF LeenenLPH Van Der VeldeDet al. 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