Achilles Sleeve Avulsion: Five-Year Outcomes​

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.