{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T05:19:27Z","timestamp":1784351967467,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Achilles tendon ruptures are common, particularly in active individuals; however, optimal healing remains challenging due to limited vascularity, adhesions, and re-rupture risk. Human amniotic membrane (hAM), rich in extracellular matrix and bioactive factors, shows regenerative potential, offering a promising adjunct for tendon repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>After institutional review board approval, patients aged 20\u201375 years who underwent end-to-end Achilles tendon repair for acute complete rupture between February 2019 and January 2025 were retrospectively reviewed. Patients were grouped by intraoperative use of hAM allografts. Baseline characteristics, rupture location, operative time, complications (tendon re-rupture, wound infection, dehiscence), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and follow-up duration were analyzed using <jats:italic>t<\/jats:italic>-tests and Fisher's exact tests (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 45 repairs were performed in 44 patients. Of these, 13 patients (13 feet) received hAM augmentation, while 31 patients (32 feet) underwent primary repair without hAM. The overall mean follow-up time for the entire cohort was 38.16\u2009\u00b1\u200921.13 months. Complications occurred in 11 of the 45 feet, including 1 wound dehiscence, 3 re-rupture (2 of which were associated with wound infection), and 7 additional cases of wound infection. Operative time was significantly shorter in the hAM group (94.00\u2009\u00b1\u200930.12 vs. 116.72\u2009\u00b1\u200924.46\u2005min, <jats:italic>p<\/jats:italic>\u2009=\u20090.011), with no significant differences in complication rates or AOFAS scores. Ruptures closer to the calcaneal insertion were associated with higher infection risk (2.86\u2009\u00b1\u20091.41\u2005cm vs. 4.36\u2009\u00b1\u20091.14\u2005cm, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Complications correlated with lower AOFAS scores (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001), independent from hAM use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The hAM augmentation reduced operative time without affecting complication rates or functional outcomes. Further prospective studies are needed to confirm its clinical benefits.<\/jats:p><jats:p>Level of evidence: IV.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1654648","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:27:30Z","timestamp":1759987650000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgical repair of acute Achilles tendon rupture with and without human amniotic membrane augmentation: a retrospective comparative study"],"prefix":"10.3389","volume":"12","author":[{"given":"Ju Chun","family":"Chien","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng Chen","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Jiun","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Ping","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"95","DOI":"10.3390\/jfmk5040095","article-title":"Achilles tendon rupture: mechanisms of injury, principles of rehabilitation and return to play","volume":"5","author":"Tarantino","year":"2020","journal-title":"J Funct Morphol Kinesiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1053\/j.jfas.2024.04.005","article-title":"Gender differences in Achilles tendon ruptures\u2014a retrospective study and a review of the literature","volume":"63","author":"Hartman","year":"2024","journal-title":"J Foot Ankle Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"355","DOI":"10.2214\/AJR.22.27632","article-title":"The Achilles tendon: imaging diagnoses and image-guided interventions\u2014AJR expert panel narrative review","volume":"219","author":"Pass","year":"2022","journal-title":"AJR Am J Roentgenol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3698","DOI":"10.3390\/jcm11133698","article-title":"Achilles tendon rupture and dysmetabolic diseases: a multicentric, epidemiologic study","volume":"11","author":"Oliva","year":"2022","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4103\/tcmj.tcmj_113_23","article-title":"Current treatment concepts for Achilles tendon rupture","volume":"36","author":"Wang","year":"2024","journal-title":"Tzu Chi Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.3390\/cells8111411","article-title":"Treatment with human amniotic suspension allograft improves tendon healing in a rat model of collagenase-induced tendinopathy","volume":"8","author":"de Girolamo","year":"2019","journal-title":"Cells"},{"key":"B7","doi-asserted-by":"publisher","first-page":"610544","DOI":"10.3389\/fbioe.2020.610544","article-title":"Perinatal derivatives: where do we stand? A roadmap of the human placenta and consensus for tissue and cell nomenclature","volume":"8","author":"Silini","year":"2020","journal-title":"Front Bioeng Biotechnol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"88","DOI":"10.22203\/ecm.v015a07","article-title":"Properties of the amniotic membrane for potential use in tissue engineering","volume":"15","author":"Niknejad","year":"2008","journal-title":"Eur Cell Mater"},{"key":"B9","doi-asserted-by":"publisher","first-page":"15556","DOI":"10.1038\/s41598-025-00596-0","article-title":"Decellularised amniotic membrane-TDSCs composite promotes Achilles tendon healing","volume":"15","author":"Mao","year":"2025","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2377","DOI":"10.3727\/096368912X638892","article-title":"Achilles tendon regeneration can be improved by amniotic epithelial cell allotransplantation","volume":"21","author":"Barboni","year":"2012","journal-title":"Cell Transplant"},{"key":"B11","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1053\/jhsu.2001.22524","article-title":"Effects of human amniotic fluid on peritendinous adhesion formation and tendon healing after flexor tendon surgery in rabbits","volume":"26","author":"Ozgenel","year":"2001","journal-title":"J Hand Surg Am"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.2106\/00004623-199173100-00009","article-title":"Histopathological changes preceding spontaneous rupture of a tendon: a controlled study of 891 patients","volume":"73","author":"Kannus","year":"1991","journal-title":"J Bone Joint Surg Am"},{"key":"B13","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.fcl.2005.01.013","article-title":"Achilles tendon disorders: etiology and epidemiology","volume":"10","author":"J\u00e4rvinen","year":"2005","journal-title":"Foot Ankle Clin"},{"key":"B14","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1097\/BTO.0000000000000229","article-title":"Dehydrated human amnion\/chorion membrane (dHACM) allografts as a therapy for orthopedic tissue repair","volume":"32","author":"Lei","year":"2017","journal-title":"Tech Orthop"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e19170","DOI":"10.7547\/19-170","article-title":"Micronized dehydrated amnion chorion membrane (mdHACM) injection in the treatment of chronic Achilles tendinitis: a large retrospective case series","volume":"111","author":"Spector","year":"2021","journal-title":"J Am Podiatr Med Assoc"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e012884","DOI":"10.1136\/bmjopen-2016-012884","article-title":"American orthopaedic foot and ankle society (AOFAS) Ankle-hindfoot score: a study protocol for the translation and validation of the Dutch language version","volume":"7","author":"Van Lieshout","year":"2017","journal-title":"BMJ Open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.hansur.2023.06.010","article-title":"Biomechanical comparison of different suture materials with different techniques in tendon repair: an ex-vivo study","volume":"42","author":"Muslu","year":"2023","journal-title":"Hand Surg Rehabil"},{"key":"B18","article-title":"HCT Regenerative. Safety","year":"2024"},{"key":"B19","doi-asserted-by":"publisher","first-page":"399","DOI":"10.3390\/life12030399","article-title":"Application of orthobiologics in Achilles tendinopathy: a review","volume":"12","author":"Ramires","year":"2022","journal-title":"Life (Basel)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e24.00144","DOI":"10.2106\/JBJS.RVW.24.00144","article-title":"Current concepts in orthobiologics for Achilles tendon injuries: a critical analysis review","volume":"12","author":"Gopinatth","year":"2024","journal-title":"JBJS Rev"},{"key":"B21","doi-asserted-by":"publisher","first-page":"434","DOI":"10.7547\/0003-0538-104.5.434","article-title":"Surgical treatment of the neglected Achilles tendon rupture with hyalonect","volume":"104","author":"Esenyel","year":"2014","journal-title":"J Am Podiatr Med Assoc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1007\/s00264-015-2725-7","article-title":"Outcomes of acute Achilles tendon rupture repair with bone marrow aspirate concentrate augmentation","volume":"39","author":"Stein","year":"2015","journal-title":"Int Orthop"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1177\/0363546516647958","article-title":"Ultrasound-guided injection therapy of Achilles tendinopathy with platelet-rich plasma or saline: a randomized, blinded, placebo-controlled trial","volume":"44","author":"Krogh","year":"2016","journal-title":"Am J Sports Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.ejrad.2017.08.006","article-title":"Magnetic resonance and ultrasound in achilles tendinopathy: predictive role and response assessment to platelet-rich plasma and adipose-derived stromal vascular fraction injection","volume":"95","author":"Albano","year":"2017","journal-title":"Eur J Radiol"},{"key":"B25","first-page":"323","article-title":"The effect of amniotic membrane transplantation on tendon healing in a rabbit Achilles tendon model","volume":"7","author":"Yang","year":"2010","journal-title":"Tissue Eng Regen Med"},{"key":"B26","first-page":"e31","article-title":"Amnion-derived multipotent progenitor cells improve Achilles tendon repair in rats","volume":"13","author":"Philip","year":"2013","journal-title":"Eplasty"},{"key":"B27","doi-asserted-by":"publisher","first-page":"100169","DOI":"10.1016\/j.fastrc.2022.100169","article-title":"Amniotic membrane\/umbilical cord particulate injection for Achilles tendinopathy with or without a partial tear","volume":"2","author":"Chin","year":"2022","journal-title":"Foot Ankle Surg Tech Rep Cases"},{"key":"B28","doi-asserted-by":"publisher","first-page":"219896","DOI":"10.1155\/2015\/219896","article-title":"Amniotic tissues for the treatment of chronic plantar fasciosis and Achilles tendinosis","volume":"2015","author":"Werber","year":"2015","journal-title":"J Sports Med (Hindawi Publ Corp"},{"key":"B29","doi-asserted-by":"publisher","first-page":"36","DOI":"10.21037\/acr-23-61","article-title":"Primary repair of complete Achilles tear augmented with amnion allograft wrap in college basketball player with a history of contralateral Achilles rupture: a case report","volume":"7","author":"Giacobazzi","year":"2023","journal-title":"AME Case Rep"},{"key":"B30","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.fas.2010.06.003","article-title":"An anatomical and radiological study of the fascia cruris and paratenon of the Achilles tendon","volume":"7","author":"Carmont","year":"2011","journal-title":"Foot Ankle Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1002\/ajum.12384","article-title":"Ultrasound assessment of acute Achilles tendon rupture and measurement of the tendon gap","volume":"27","author":"Fenech","year":"2024","journal-title":"Australas J Ultrasound Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1111\/iwj.12035","article-title":"Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non-healing wounds","volume":"11","author":"Sheikh","year":"2014","journal-title":"Int Wound J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.1007\/s00784-019-03104-7","article-title":"Use of amniotic membrane for radial forearm free flap donor site coverage: clinical, functional and cosmetic outcomes","volume":"24","author":"Hunger","year":"2020","journal-title":"Clin Oral Investig"},{"key":"B34","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1053\/j.otsm.2017.07.009","article-title":"Rehabilitation and return to play following Achilles tendon repair","volume":"25","author":"Wang","year":"2017","journal-title":"Oper Tech Sports Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1136\/bjsports-2016-096106","article-title":"Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play","volume":"50","author":"Zellers","year":"2016","journal-title":"Br J Sports Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"494","DOI":"10.4049\/jimmunol.88.4.494","article-title":"A bactericidin for Bacillus subtilis in pregnancy","volume":"88","author":"Gusdon","year":"1962","journal-title":"J Immunol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/0002-9378(70)90126-2","article-title":"Antimicrobial factors in amniotic fluid","volume":"106","author":"Galask","year":"1970","journal-title":"Am J Obstet Gynecol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s11892-020-01316-w","article-title":"Immunomodulatory properties of amniotic membrane derivatives and their potential in regenerative medicine","volume":"20","author":"Wassmer","year":"2020","journal-title":"Curr Diab Rep"},{"key":"B39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/s10561-017-9618-5","article-title":"Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting\u2014a review","volume":"18","author":"Jirsova","year":"2017","journal-title":"Cell Tissue Bank"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2473011418814004","DOI":"10.1177\/2473011418814004","article-title":"A comparison of wound complications with surgical treatment of achilles tendon conditions using two surgical approaches","volume":"4","author":"Hippensteel","year":"2019","journal-title":"Foot Ankle Orthop"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.2106\/JBJS.I.00743","article-title":"Digital vascular mapping of the integument about the Achilles tendon","volume":"92","author":"Yepes","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"B42","doi-asserted-by":"publisher","first-page":"941","DOI":"10.3390\/membranes11120941","article-title":"Using of amniotic membrane derivatives for the treatment of chronic wounds","volume":"11","author":"Schmiedova","year":"2021","journal-title":"Membranes (Basel)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"968346","DOI":"10.3389\/fbioe.2022.968346","article-title":"Human amniotic membrane application in oral surgery-an ex vivo pilot study","volume":"10","author":"Odet","year":"2022","journal-title":"Front Bioeng Biotechnol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"961987","DOI":"10.3389\/fbioe.2022.961987","article-title":"General consensus on multimodal functions and validation analysis of perinatal derivatives for regenerative medicine applications","volume":"10","author":"Pozzobon","year":"2022","journal-title":"Front Bioeng Biotechnol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1654648\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:27:31Z","timestamp":1759987651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1654648\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":44,"alternative-id":["10.3389\/fsurg.2025.1654648"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1654648","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]},"article-number":"1654648"}}