{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:31:08Z","timestamp":1781789468212,"version":"3.54.5"},"reference-count":41,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The absence of a comprehensive classification system for Achilles tendon (AT) injuries contributes to the lack of consensus regarding optimal treatment strategies, as it hinders accurate differentiation of injury types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate epidemiology of AT ruptures to develop a magnetic resonance imaging\u2013based classification system for rupture location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A search was conducted for all patients with acute AT injuries between 2016 and 2023. Tear locations were classified as follows: type 1 (musculotendinous junction; MTJ), type 1A (2-cm zone distal to MTJ), type 2 (midsubstance), type 3 (2-cm zone proximal to insertion), type 3A (soft tissue \u201cpeel-off\u201d), type 3B (calcaneal bony avulsion). Clinicodemographic data were collected, and rupture gap size, tendon thickness, tibiotalar, and plantarflexion angle were measured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 428 patients were included (age 45 \u00b1 15 years; 17% female). Mean rupture gap size was 30 \u00b1 16 mm in 73\u00b0\u00b1 8\u00b0 tibiotalar flexion. AT tear distribution: type 1, 62.7%; type 1A, 16.3%; type 2, 13.8%; type 3, 0.7%; type 3A, 5.8%; and type 3B, 0.7%. Female patients demonstrated lower tendon thickness (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and a significantly higher prevalence of type 3, 3A, and 3B (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Multivariate analysis revealed that proximal AT tears were associated with presence of tendinopathy (odds ratio [OR], 2.19; 95% CI, 1.24-3.83), while younger age and larger gap size were significant but with a weak effect size. Midsubstance tears were predicted by older age and increased tendon thickness (OR, 1.02-1.17). Distal tears were associated with absence of tendinopathy (OR, 0.17; 95% CI, 0.07-0.39), while age only had a small effect. Tear location measurements demonstrated substantial to almost perfect interobserver (3 observers; n = 35; Cohen's kappa = 0.93; 95% CI, 0.74-0.99) and intraobserver (1 observer; n = 35; Cohen's kappa = 0.93; 95% CI, 0.86-0.99) reliability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study introduces an AT tear classification system that demonstrated substantial to almost perfect reliability. AT ruptures at the MTJ were most common (63%). Presence of tendinopathy, age, gap size, and tendon thickness were significant predictors for AT tear type. Female patients exhibited lower tendon thickness and a significantly higher prevalence of distal tear location. Studies with larger cohort sizes are necessary to confirm the current findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261428092","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T15:00:17Z","timestamp":1775228417000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["MRI-Based Classification of Achilles Tendon Ruptures: Reliability and Predictors of Tear Location"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6456-9518","authenticated-orcid":false,"given":"Maximilian M.","family":"Mueller","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"},{"name":"Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5380-3996","authenticated-orcid":false,"given":"Andrea","family":"Estfeller","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"},{"name":"Department of Orthopedics and Trauma-Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Cychosz","sequence":"additional","affiliation":[{"name":"Slocum Center for Orthopaedics &amp; Sports Medicine, Eugene, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6650-3166","authenticated-orcid":false,"given":"Robert E.","family":"Bilodeau","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"},{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany M.","family":"Ammerman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prerana","family":"Katiyar","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-8276","authenticated-orcid":false,"given":"Craig E.","family":"Klinger","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9559-757X","authenticated-orcid":false,"given":"Gregory S.","family":"DiFelice","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6261-6930","authenticated-orcid":false,"given":"Steve B.","family":"Behrens","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58091195"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100719845016"},{"issue":"3","key":"e_1_3_2_4_2","first-page":"252","article-title":"Epidemiological, clinical and therapeutic characteristics of Achilles tendon rupture. 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