{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:43:22Z","timestamp":1789663402353,"version":"4.0.1"},"reference-count":53,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007065","name":"Universit\u00e0 degli Studi di Salerno","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007065","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007065","name":"Universit\u00e0 degli Studi di Salerno","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>After four weeks from injury, tears of the Achilles tendon are considered chronic. Their management is challenging, and the use of a graft is suggested when the gap between proximal and distal stumps is greater than 6\u00a0cm. The present study systematically reviews the outcome of free tendon grafts in chronic ruptures of the Achilles tendon, evaluating clinical outcomes, complications and return to sport.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in February 2023. All the published clinical studies reporting clinical outcome, return to sport and complications of free tendon grafts used the treatment of chronic rupture of the midportion of the Achilles Tendon were accessed. The mean CMS (Coleman Methodology Score) of 65.7 suggested an overall good quality of the available published articles, attesting to the low risk of bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 22 articles (368 patients with a mean age of 47 years) were retrieved. The average time from rupture to surgery was 25.1 week. At last follow\u2010up, the AOFAS (American Orthopaedic Foot and Ankle Surgery) and ATRS (Achilles Tendon Total Rupture Score) scores improved of 33.8 (P\u2009=\u20090.0004), and 45.1 points (P\u2009=\u20090.0001) respectively. Return to activity was reported in 105 patients, and 82 (78.1%) had no activity limitations, while 19 (18.1%) had limited recreational but not daily activity limitations, and 4 (3.8%) reported limitations in daily activities. Return to sport data was reported in six studies, and 45 of 93 (48.4%) patients returned to sport at an average of 22.6 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In chronic tears of the Achilles tendon, with a gap of at least 6\u00a0cm, free tendon grafts allow predictable return to sport and acceptable recovery function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07446-4","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T23:27:22Z","timestamp":1684279642000},"page":"4526-4538","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Free tendon grafts for surgical management of chronic tears of the main body of the Achilles tendon: a systematic review"],"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 Musculoskeletal Disorders, Faculty of Medicine and Surgery University of Salerno 84084 Baronissi Italy"},{"name":"<!--<label>2<\/label>--> Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d\u2019Aragona 84131 Salerno Italy"},{"name":"<!--<label>3<\/label>--> Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry Queen Mary University of London, Mile End Hospital 275 Bancroft Road E1 4DG London UK"},{"name":"<!--<label>4<\/label>--> School of Pharmacy and Bioengineering, Faculty of Medicine Keele University Thornburrow Drive ST4 7QB Stoke on Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bartoli","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery University of Salerno 84084 Baronissi Italy"},{"name":"<!--<label>2<\/label>--> Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d\u2019Aragona 84131 Salerno Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliano","family":"Sammaria","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery University of Salerno 84084 Baronissi Italy"},{"name":"<!--<label>2<\/label>--> Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d\u2019Aragona 84131 Salerno Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Migliorini","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Orthopaedic, Trauma, and Reconstructive Surgery RWTH University Hospital 52074 Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Karlsson","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg G\u00f6teborgsv\u00e4gen 31, M\u00f6lndal 431 80 Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Oliva","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery University of Salerno 84084 Baronissi Italy"},{"name":"<!--<label>2<\/label>--> Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d\u2019Aragona 84131 Salerno 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