Aim This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. Design Systematic review and meta-analysis. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. Data Sources PubMed, CINAHL, Web of Science, and Scopus databases were searched to identify potentially relevant articles. Eligibility criteria for selecting studies Studies reporting return to play/sport/sport activity in acute, closed Achilles tendon rupture were included. Results A total of 108 studies encompassing 6,506 patients were included for review. Eighty-five studies included a measure for determining RTP. The rate of RTP in all studies was 80% (CI95%: 75 – 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p < 0.001). Conclusions Eighty percent of patients returned to play following Achilles tendon rupture, however, the return to play rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable, and valid method is required.

Level III, case-control study.

Background:The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications.Purpose:To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures.Study Design:Cohort study; Level of evidence, 3.Methods:Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks.Results:There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively).Conclusion:Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.

The purposes of this study were to 1) evaluate the intra-rater reliability of estimating Achilles tendon mechanical properties with continuous shear wave elastography (cSWE), 2) propose an equivalent shear modulus comparable to Supersonic Shear Imaging, 3) demonstrate construct validity of cSWE, and 4) explore relationships between tensile and shear properties. Achilles tendon mechanical properties were estimated with cSWE at four time points throughout a fourhour period and at a 2-week follow up. Additionally, properties were estimated with cSWE across four different ankle positions. In these four positions, B-mode ultrasound imaging and dynamometry were used to quantify Young's modulus. Intra-rater reliability was fair-to-excellent for Achilles tendon mechanical properties estimated with cSWE. Construct validity was demonstrated with increased ankle dorsiflexion leading to increased mechanical properties. Linear relationships were found between tensile and shear mechanical properties. Findings demonstrate that cSWE has sufficient intra-rater reliability and validity for estimating Achilles tendon mechanical properties.

Purpose Optimizing tendon structural recovery during the first 12 weeks after Achilles tendon rupture is a prime target to improve patient outcomes, but a comprehensive understanding of biomarkers is needed to track early healing. The purpose of this study was to observe healing of tendon structure over time using ultrasound‐based, tendon‐specific measures and to identify relationships between tendon structural characteristics and clinical measures of gait and strength. Methods Twenty‐seven participants (21 males, mean (SD) age 39 (11) years) were assessed at 4, 8, 12, and 24 weeks after injury or surgery using ultrasound imaging techniques. Gait analysis and strength testing were added at the later time points. Results Ruptured tendons had significantly lower dynamic shear modulus (p < 0.001), greater tendon cross‐sectional area (p < 0.001), and greater length (p < 0.001) than the uninjured side. Dynamic shear modulus, cross‐sectional area, and length were found to increase over time (p < 0.01). Tendon structure at 4 weeks post‐injury [cross‐sectional area symmetry (r = 0.737, p = 0.002) and dynamic shear modulus (r = 0.518, p = 0.040)] related to stance phase walking symmetry at 24 weeks. Conclusions Tendon structure assessed by ultrasound imaging changes over the first 24 weeks of healing after Achilles tendon rupture, suggesting it could be used as a biomarker to track tendon healing early in recovery. Additionally, tendon structure within the first 12 weeks relates to later walking gait and heel‐rise symmetry, which may indicate that tendon structure could have prognostic value in the care of these patients. This study's clinical relevance is in its support for using ultrasound imaging to assess early patient healing and prognosticate later patient outcomes after Achilles tendon rupture. Level of evidence Level 2, prospective cohort prognostic study.