Achilles Sleeve Avulsion: Five-Year Outcomes

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Does insertional reattachment surgery deliver durable pain relief, function, and return to sport at two and five years?

 

In a retrospective cohort study, researchers reviewed 39 patients (mean age 45; 92% male) who had the procedure between 2011 and 2019. The results were encouraging across multiple measures.

 

Pain, function improvements, and return to activity

 

At the five-year follow-up, the treatment demonstrated these improvements:

 

• Pain scores improved, dropping from 4.7  to 0.7 on a visual analog scale by the five-year mark.

• American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 50 to 96.

• Foot Function Index fell from 110 to five.

• 64% of all patients returned to sports, with 78% of preinjury athletes still active at five years. 

• Patients resumed activities in an average of eight months.

• Activity levels improved from one to four on the Tegner scale and remained stable at the five-year follow-up.

• 13% of patients experienced delayed wound healing

• 8% of patients had re-rupture.

 

Who benefits most?

 

Certain factors predicted worse 5-year outcomes, including:


• Older age (lower activity levels)

• Preinjury insertional pain

• Prior corticosteroid injections

 

The surgery proved most effective for patients without prior tendinopathy.

 

Long-term success in select patients

 

The findings suggest insertional reattachment surgery delivers meaningful, durable improvement in pain and function while enabling strong long-term sports participation.

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Geriatric Ankle Fractures: Fixation Affects Function

by Vince Vacketta, DPM

 

Geriatric ankle fractures carry high morbidity. Fixation choice influences early weight-bearing, mobilization, complication risk, and functional recovery – all critical in frail patients where prolonged immobility can be devastating.

 

Study overview

 

In a recent prospective multicenter study, researchers compared fibular nailing (FN) versus locking plate fixation (ORIF) in 55 elderly, medically complex patients with unstable ankle fractures across two trauma centers.

 

Major results

 

Early weight-bearing: FN outperformed ORIF

• Full weight-bearing at discharge: 62% FN versus 0% ORIF

• Better early-function scores at six weeks:

• AOFAS: FN > ORIF

• OMAS: FN > ORIF

 

Radiographic alignment: ORIF superior, but clinically irrelevant:

 

• FN showed higher malalignment rates

• This did not increase complication or reoperations

 

Long-term outcomes: equivalent at 12 months

• No significant functional differences between groups

• FN actually required few reoperations (26% FN versus 38% ORIF)

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Bottom line

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In geriatric patients, time matters! Fibular nailing may offer meaningful short-term advantages with early weight-bearing and return to function, though long-term outcomes equivalent to plating.

 

 

Deltoid Ligament Augmentation Shows Promise as Alternative to Screw Fixation for Ankle Fractures

 

A randomized controlled trial investigated whether the deltoid ligament augmentation (DLA) could replace trans-syndesmotic screw fixation (TSSF). 

 

Study design and results

 

The study enrolled 59 patients, including 30 receiving DLA and 29 receiving TSSF, and followed them for one year. The AOFAS score was the primary outcome measure. 

 

Key findings:

 

• At one year, both approaches produced equivalent AOFAS scores.

• At three months, the DLA group showed better AOFAS scores and better performance on the Philips & Schwartz scale and SF-36 physical and social scores.

• DLA patients returned to partial/full weight-bearing, work, and sports faster.

• Radiographic evaluation at one year showed no differences.

• Neither group experienced major complications.

 

Clinical implications

 

DLA delivers similar one-year outcomes but faster early recovery versus screw fixation. These findings establish DLA as a viable alternative treatment option for ankle fractures with deltoid rupture and syndesmotic instability.