{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:38:01Z","timestamp":1791221881654,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,17]]},"abstract":"\n Background:<\/jats:title>\n Acute Achilles tendon rupture is a common and serious injury in sports medicine. Clinical studies demonstrate that both surgical and nonsurgical interventions can achieve satisfactory outcomes; however, considerable debate exists regarding the optimal treatment modality for this injury. Currently, most animal experimental studies on acute Achilles tendon rupture lack clinical relevance due to inadequate fixation of the ankle joint.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n This study involved 162 male C57BL\/6 mice and 30 Scx-CreER\n T2<\/jats:sup>\n ; Rosa26-tdTomato transgenic mice. The injury+repair groups underwent Achilles tenotomy followed by Kessler suture repair, while the injury+no repair groups underwent tenotomy alone. Ankle joints were immobilized at 160\u00b0 (plantar flexion) or 90\u00b0 (neutral alignment). Samples were collected at 2 and 4 weeks post-injury for biomechanical, histological, and quantitative real-time PCR (qPCR) analyses, including tracing of Scx\n +<\/jats:sup>\n tendon progenitor stem cells.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Biomechanical analysis was performed 2 and 4 weeks post-injury. At 2 weeks, the injury+repair group immobilized at a maximum plantar flexion angle of 160\u00b0 showed significantly higher failure force and stiffness compared with the injury+no repair+160\u00b0 group. However, there was no significant difference between the groups at 4 weeks (p > 0.05). The failure force in each 160\u00b0 group was significantly higher than in the corresponding 90\u00b0 group (p < 0.0001). Histological analysis indicated better collagen fiber alignment and higher expression of collagen type I alpha 1 (COL1A1) in the injury+repair groups. qPCR revealed generally higher expression of tendon repair-related genes (\n Scx, Tnmd, Tgfb1<\/jats:italic>\n ) in the injury+repair groups, while inflammatory factors (\n Il1b, Il6<\/jats:italic>\n ) were higher in the injury+no repair+90\u00b0 group. Scx\n +<\/jats:sup>\n tendon progenitor stem cell tracing showed the greatest percentage in the injury+repair+160\u00b0 group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Both surgical and nonsurgical treatments for acute Achilles tendon rupture achieved satisfactory tendon healing results when the ankle joint was maintained in maximum plantar flexion. However, surgical treatment yielded superior histological tendon repair.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance:<\/jats:title>\n The results suggest that clinical trials may show immobilization in maximum plantar flexion following surgery to be optimal for tendon healing.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.25.01211","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T18:00:32Z","timestamp":1773338432000},"page":"929-938","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Efficacy of Surgical Versus Nonsurgical Management for Acute Achilles Tendon Rupture in a Novel Mouse Model"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0441-5627","authenticated-orcid":false,"given":"Keyu","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3218-3182","authenticated-orcid":false,"given":"Xiang-Hua","family":"Deng","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8724-630X","authenticated-orcid":false,"given":"Yuexi","family":"Mou","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7406-892X","authenticated-orcid":false,"given":"Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8082-096X","authenticated-orcid":false,"given":"Xianding","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3295-3482","authenticated-orcid":false,"given":"Mao","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"issue":"2","key":"bib1-20260619","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0030-5898(20)31990-8","article-title":"Repair of acute Achilles tendon ruptures","volume":"26","author":"Soma","year":"1995","journal-title":"Orthop Clin North Am."},{"issue":"12","key":"bib2-20260619","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.2106\/00004623-200012000-00014","article-title":"Rupture of the Achilles tendon","volume":"82","author":"Martinelli","year":"2000","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib3-20260619","doi-asserted-by":"crossref","first-page":"3730","DOI":"10.1007\/s00167-015-3544-5","article-title":"Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients","volume":"24","author":"Ganestam","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"13","key":"bib4-20260619","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.2106\/JBJS.J.01601","article-title":"Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients","volume":"94","author":"Bergkvist","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"23","key":"bib5-20260619","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.2106\/JBJS.K.00917","article-title":"Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials","volume":"94","author":"Soroceanu","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"14","key":"bib6-20260619","first-page":"2466","article-title":"American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture","volume":"92","author":"Chiodo","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib7-20260619","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1177\/0363546510376052","article-title":"Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures","volume":"38","author":"Nilsson-Helander","year":"2010","journal-title":"Am J Sports Med."},{"issue":"1","key":"bib8-20260619","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/0363546506293255","article-title":"Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens","volume":"35","author":"Kangas","year":"2007","journal-title":"Am J Sports Med."},{"issue":"15","key":"bib9-20260619","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1056\/NEJMoa2108447","article-title":"Nonoperative or Surgical Treatment of Acute Achilles\u2019 Tendon Rupture","volume":"386","author":"Myhrvold","year":"2022","journal-title":"N Engl J Med."},{"issue":"2","key":"bib10-20260619","doi-asserted-by":"crossref","first-page":"23259671231152904","DOI":"10.1177\/23259671231152904","article-title":"Operative Versus Nonoperative Treatment of Acute Achilles Tendon Rupture: A Propensity Score-Matched Analysis of a Large National Dataset","volume":"11","author":"Crook","year":"2023","journal-title":"Orthop J Sports Med."},{"issue":"12","key":"bib11-20260619","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1177\/0363546507307503","article-title":"Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study","volume":"35","author":"Twaddle","year":"2007","journal-title":"Am J Sports Med."},{"issue":"22","key":"bib12-20260619","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.2106\/JBJS.22.00965","article-title":"In Adults with Acute Achilles Tendon Rupture, Nonoperative Treatment, Open Repair, and Minimally Invasive Surgery Did Not Differ for Health Status at 12 Months","volume":"104","author":"Maffulli","year":"2022","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib13-20260619","doi-asserted-by":"crossref","first-page":"3528","DOI":"10.1007\/s00167-023-07411-1","article-title":"Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute Achilles tendon ruptures: a systematic review of overlapping meta-analyses","volume":"31","author":"Seow","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"11","key":"bib14-20260619","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1177\/1071100715589632","article-title":"Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures","volume":"36","author":"Hsu","year":"2015","journal-title":"Foot Ankle Int."},{"issue":"7","key":"bib15-20260619","doi-asserted-by":"crossref","first-page":"2664","DOI":"10.1002\/ksa.12686","article-title":"Open surgical repair as gold standard for acute Achilles tendon ruptures: Systematic review and network meta-analysis","volume":"33","author":"Pisano","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"1","key":"bib16-20260619","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1186\/s13018-025-05990-y","article-title":"Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis","volume":"20","author":"Yang","year":"2025","journal-title":"J Orthop Surg Res."},{"issue":"5","key":"bib17-20260619","doi-asserted-by":"crossref","first-page":"438","DOI":"10.4085\/1062-6050-356-19","article-title":"Current Clinical Concepts: Conservative Management of Achilles Tendinopathy","volume":"55","author":"Silbernagel","year":"2020","journal-title":"J Athl Train."},{"issue":"14","key":"bib18-20260619","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.2106\/JBJS.15.01117","article-title":"Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair","volume":"98","author":"Bae","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib19-20260619","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s10856-017-5858-y","article-title":"A review on animal models and treatments for the reconstruction of Achilles and flexor tendons","volume":"28","author":"Bottagisio","year":"2017","journal-title":"J Mater Sci Mater Med."},{"issue":"9","key":"bib20-20260619","doi-asserted-by":"crossref","first-page":"635","DOI":"10.5435\/JAAOS-D-16-00620","article-title":"Temporal Healing of Achilles Tendons After Injury in Rodents Depends on Surgical Treatment and Activity","volume":"25","author":"Freedman","year":"2017","journal-title":"J Am Acad Orthop Surg."},{"issue":"6","key":"bib21-20260619","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s00264-007-0398-6","article-title":"Stimulation of tendon repair: mechanical loading, GDFs and platelets. A mini-review","volume":"31","author":"Aspenberg","year":"2007","journal-title":"Int Orthop."},{"issue":"3","key":"bib22-20260619","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1002\/jor.24241","article-title":"Effects of immobilization angle on tendon healing after Achilles rupture in a rat model","volume":"37","author":"Hillin","year":"2019","journal-title":"J Orthop Res."},{"issue":"13","key":"bib23-20260619","doi-asserted-by":"crossref","first-page":"2607","DOI":"10.1016\/j.jbiomech.2016.05.023","article-title":"Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials","volume":"49","author":"Jordan","year":"2016","journal-title":"J Biomech."},{"issue":"11","key":"bib24-20260619","doi-asserted-by":"crossref","first-page":"2960","DOI":"10.1111\/os.13860","article-title":"Methods of Immobilization after Achilles Tendon Rupture Repair: A Comparative Study in Rat Model","volume":"15","author":"Wang","year":"2023","journal-title":"Orthop Surg."},{"issue":"2","key":"bib25-20260619","doi-asserted-by":"crossref","first-page":"85","DOI":"10.2106\/JBJS.O.00496","article-title":"Augmented Compared with Nonaugmented Surgical Repair After Total Achilles Rupture: Results of a Prospective Randomized Trial with Thirteen or More Years of Follow-up","volume":"98","author":"Heikkinen","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib26-20260619","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.2106\/JBJS.G.01089","article-title":"Augmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study","volume":"91","author":"Pajala","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib27-20260619","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1177\/0363546517694610","article-title":"Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments","volume":"45","author":"Heikkinen","year":"2017","journal-title":"Am J Sports Med."},{"issue":"9","key":"bib28-20260619","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1177\/0363546516651060","article-title":"A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures","volume":"44","author":"Lantto","year":"2016","journal-title":"Am J Sports Med."},{"issue":"3","key":"bib29-20260619","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.fcl.2019.04.003","article-title":"Maximizing Return to Sports After Achilles Tendon Rupture in Athletes","volume":"24","author":"Caldwell","year":"2019","journal-title":"Foot Ankle Clin."},{"issue":"1","key":"bib30-20260619","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3113\/FAI.2011.0009","article-title":"Achilles tendon ruptures in elite athletes","volume":"32","author":"Maffulli","year":"2011","journal-title":"Foot Ankle Int."},{"issue":"1","key":"bib31-20260619","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1177\/03635465231212669","article-title":"The Delayed Presentation of Achilles Tendon Ruptures Is Associated With Marked Alterations in the Gene Expression of COL1A1, MMPs, TIMPs, and IL-6","volume":"52","author":"Nilsson","year":"2024","journal-title":"Am J Sports Med."},{"key":"bib32-20260619","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.actbio.2025.01.023","article-title":"Quantification of 3D microstructures in Achilles tendons during in situ loading reveals anisotropic fiber response","volume":"194","author":"Pierantoni","year":"2025","journal-title":"Acta Biomater."},{"issue":"12","key":"bib33-20260619","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.3113\/FAI.2012.1093","article-title":"Immediate weight bearing after modified percutaneous Achilles tendon repair","volume":"33","author":"Patel","year":"2012","journal-title":"Foot Ankle Int."},{"key":"bib34-20260619","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.actbio.2023.12.015","article-title":"Micro- and nanostructure specific X-ray tomography reveals less matrix formation and altered collagen organization following reduced loading during Achilles tendon healing","volume":"174","author":"Silva Barreto","year":"2024","journal-title":"Acta Biomater."},{"issue":"2","key":"bib35-20260619","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1152\/physrev.00031.2003","article-title":"Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading","volume":"84","author":"Kjaer","year":"2004","journal-title":"Physiol Rev."},{"issue":"10","key":"bib36-20260619","doi-asserted-by":"crossref","first-page":"e3116","DOI":"10.1038\/cddis.2017.510","article-title":"Tenomodulin is essential for prevention of adipocyte accumulation and fibrovascular scar formation during early tendon healing","volume":"8","author":"Lin","year":"2017","journal-title":"Cell Death Dis."},{"issue":"1","key":"bib37-20260619","doi-asserted-by":"crossref","first-page":"3734","DOI":"10.1038\/s41467-025-59010-y","article-title":"PI3K-Akt signalling regulates Scx-lineage tenocytes and Tppp3-lineage paratenon sheath cells in neonatal tendon regeneration","volume":"16","author":"Goto","year":"2025","journal-title":"Nat Commun."},{"issue":"1","key":"bib38-20260619","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12867-015-0036-6","article-title":"Mechanical stimulation of human tendon stem\/progenitor cells results in upregulation of matrix proteins, integrins and MMPs, and activation of p38 and ERK1\/2 kinases","volume":"16","author":"Popov","year":"2015","journal-title":"BMC Mol Biol."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:52:38Z","timestamp":1787752358000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01211","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}