Katarina Nilsson-Helander

University of Gothenburg Institute of Clinical Sciences · Dep of Orthopaedics Sahlgrenska University Hospital Mölndal Sweden

Purpose The aim of this study was to investigate how fear of reinjury to the Achilles tendon affects return to previous levels of physical activity and self‐reported Achilles tendon Total Rupture Score (ATRS) outcomes. Methods Data were collected from a large cohort of patients treated for an acute Achilles tendon rupture at Sahlgrenska University...

To develop a core outcome set for Achilles tendinopathy (COS-AT) for use in clinical trials we performed a five-step process including (1) a systematic review of available outcome measurement instruments, (2) an online survey on truth and feasibility of the available measurement instruments, (3) an assessment of the methodological quality of the se...

Purpose Achilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to sutu...

Background As the use of patient-reported outcome measures (PROMs) is increasing in orthopaedic research, there is also a growing need for a standardized interpretation of these scores, such as the Patient Acceptable Symptom State (PASS), defined as the value beyond which patients consider themselves well. The Achilles tendon Total Rupture Score (A...

Introduction Peroneus brevis split rupture poses a diagnostic challenge, often requiring magnetic resonance imaging (MRI), yet splits are missed in initial radiological reports. However, the frequency of reported peroneus brevis split rupture in clinical MRI examinations is unknown. Aim This study aimed to investigate underreporting frequency of p...

Purpose There is a lack of knowledge concerning differences between females and males in the early stages after an acute Achilles tendon rupture. This article aims to explore the different factors affecting early function after an Achilles tendon rupture with a validated test battery that includes functional tests, clinical measurements and patient...

Purpose The linear encoder and the Calf Raise App have been shown to be valid for measurements of plantar flexor muscular endurance in the heel raise test when compared with gold standard equipment. However, the validity of the Calf Raise App has not yet been compared with a linear encoder, an instrument commonly used in clinical and research setti...

Background Both acute and chronic Achilles tendon ruptures are affected by alterations in the extracellular matrix during the healing process of the tendon. Yet, these alterations in gene expression patterns are not well characterized. Purpose To characterize temporal and spatial differences in gene expression patterns after an Achilles tendon rup...

Introduction A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft. Methods A systematic search was conducted in th...

Purpose: Achilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to sut...

The Achilles tendon often withstands extensive power and is commonly subject to acute ruptures and chronic overuse pathologies. The incidence of Achilles tendon ruptures and Achilles tendinopathy is increasing, and a thorough clinical examination is essential in establishing the diagnosis. To fully recover from Achilles tendon rupture and Achilles...

Purpose: Greater trochanteric pain syndrome (GTPS) is a term covering different conditions generating lateral hip pain. Recalcitrant cases may require surgery but there are only a few studies evaluating endoscopic treatment. This study aimed to evaluate the outcome of endoscopically treated GTPS at minimum two years postoperatively using patient-r...

Introduction: A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft. Methods: A systematic search was conducted in t...

Both in tendon repair following a tear and in tendinopathy, recovery from pain and restoration of (acceptable) function does not go hand in hand with the appearance of the affected tendon at imaging. The tendon may remain altered for a long while and possibly forever, indicating a possible dissociation between morphology and symptoms. The predictiv...

Background Achilles tendon rupture is common among physically active individuals, yet a high percentage fail to return to their former activity after the injury. Quantifiable factors such as type of treatment, hours of rehabilitation, and age have not been associated with return-to-play rates. A factor that influences recovery is the participant’s...

Objectives Management strategies of the Covid pandemic included isolation to prevent transmission. This study aimed to determine if the pandemic of 2020 influenced the epidemiology of Achilles Tendon Rupture (ATR). Methods The demographics of presentations from the local population to xxx hospital, Shropshire, United Kingdom with an ATR were analy...

Introduction The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared w...

Purpose The aim of this study was to investigate how the Achilles tendon resting angle (ATRA), an indirect measurement of tendon elongation, correlates with ultrasonography (US) measurements of the Achilles tendon length 6 and 12 months after an acute ATR and relates to other clinical outcome measurements such as heel-rise height, jumping ability a...

Purpose: To determine the relationships among calf muscle function, tendon length and gait biomechanics in patients surgically treated for chronic Achilles tendon rupture. Methods: Twenty-one patients with chronic Achilles tendon rupture (mean age 62 ± 13 years) were evaluated by heel-rise endurance test, Achilles Tendon Resting Angle (ATRA), ul...

Background Delayed treatment of Achilles tendon ruptures is generally due to either misdiagnosis or patient delay. When the treatment is delayed more than 4 weeks, the rupture is defined as “chronic”, and almost always requires more invasive surgery and longer rehabilitation time compared with acute Achilles tendon ruptures. There is insufficient k...

Purpose Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an e...

Achilles tendinopathy is a common overuse injury, especially among runners. It should be divided into midportion Achilles tendinopathy and insertional Achilles tendinopathy, as the treatments are different. Achilles tendinopathy is a clinical diagnosis, which includes a combination of pain, swelling and stiffness. If pain is located 2-6 cm above th...

Abstract Background Chronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not b...

Purpose Evaluate the one-year postoperative outcomes in patients with Chronic Achilles tendon rupture. Methods Patients surgically treated for Chronic Achilles tendon rupture ( n = 22, 14 males and 8 females, mean age 61 ± 15) were evaluated by Achilles tendon Total Rupture Score, The Physical Activity Scale, The Foot and Ankle Outcome Score, Calf...

PurposeOperative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions.Methods From February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have...

Background Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function. Indications...

Introduction Leg immobilisation in a cast or an orthosis after lower limb injuries is associated with a high risk of complications of venous thromboembolism (VTE) and hampered healing. Current pharmacoprophylaxes of VTE are inefficient and associated with adverse events. Intermittent pneumatic compression (IPC) could represent a novel, efficient an...

The most common disorder affecting the Achilles tendon is midportion tendinopathy. A focal fluid signal indicates microtears, which may progress to partial and complete rupture. Assessment of Achilles tendon healing should be based on tendon morphology and tension rather than structural signal. After nonoperative management or surgical repair of th...

The normal Achilles tendon is composed of twisted subtendons separated by thin high signal septae, which are a potential pitfall on MRI because they mimic a tendon tear. Tendinopathy and full thickness tears may be assessed effectively both on MRI and ultrasound. MRI is superior to ultrasound in detection of partial tears and for postoperative asse...

Purpose: While most Achilles tendon ruptures are dramatic and diagnosed quickly, some are missed, with a risk of becoming chronic. A chronic Achilles tendon rupture is defined as a rupture that has been left untreated for more than 4 weeks. By mapping the health economic cost of chronic Achilles tendon ruptures the health-care system might be able...

Basketball is a springing, jumping, and sprinting sport with players repetitively jumping to play shots and to make and receive passes or work sudden sprints together with the start–stop nature of the game. In the United States, sporting activity was responsible for 68% tendon ruptures, of which basketball was the most commonly involved sport, acco...

Background During management of Achilles tendon rupture, determination of tendon-end approximation, either clinically or by ultrasound is difficult, following brace application of during loading. The Radiographic Achilles Tendon Loading Angle (RadATLA) is proposed as a method of measuring ankle position whilst loading in a brace during the manageme...

Background The Achilles tendon Total Rupture Score (ATRS) is a commonly used patient-reported outcome measure for patients with an acute Achilles tendon rupture. The score consists of 10 questions, the last 3 of which include activities that some patients cannot or do not do. No instruction manual has been developed for the ATRS. Hypothesis/Purpos...

Background Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of r...

Achilles tendon ruptures are increasing in incidence, with the greatest incidence in the over 60s age group. The rehabilitation time following this injury is prolonged and patients have calf weakness of up to 30%.

Introduction The Achilles tendon Total Rupture Score (ATRS) is the most commonly used patient reported outcome in patients with an acute Achilles tendon rupture. The score contains ten items of which the last three concerns tasks that some patients cannot and some do not perform. No manual for the use of ATRS has been developed. The purpose was to...

Purpose This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Ba...

Background There is limited evidence regarding the patient-related factors that influence treatment outcomes after an acute Achilles tendon rupture. Purpose/Hypothesis The purpose of this study was to determine the predictors of functional and patient-reported outcomes 1 year after an acute Achilles tendon rupture using a multicenter cohort and to...

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Purpose: An Achilles tendon rupture is a common injury that typically affects people in the middle of their working lives. The injury has a negative impact in terms of both morbidity for the individual and the risk of substantial sick leave. The aim of this study was to investigate the cost-effectiveness of surgical compared with non-surgical mana...

Purpose: The aim of this study was to perform a long-term follow-up of patients treated for an Achilles tendon re-rupture, using established outcome measurements for tendon structure, lower extremity function and symptoms, and to compare the results with those for the uninjured side. A secondary aim was to compare the outcome with that of patients...

Abstract Background Rupture of the Achilles tendon often leads to long-term morbidity, particularly calf weakness associated with tendon elongation. Operative repair of Achilles tendon ruptures leads to reduced tendon elongation. Tendon lengthening is a key problem in the restoration of function following Achilles tendon rupture. A study was perfor...

Background: Optimizing calf muscle performance seems to play an important role in minimizing impairments and symptoms after an Achilles tendon rupture (ATR). The literature lacks long-term follow-up studies after ATR that describe calf muscle performance over time. Purpose: The primary aim was to evaluate calf muscle performance and patient-repo...

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 complication...

Purpose: The relationship between the duration of operative time (DOT), healing response and patient outcome has not been previously investigated. An enhanced healing response related to DOT may potentiate repair processes, especially in hypovascular and sparsely metabolized musculoskeletal tissues such as tendons. This study aimed to investigate...

Open reconstruction of the Achilles tendon may be considered to be a relatively simple technique and may be easily performed by surgeons less familiar with more complex Achilles reconstruction. The technique may be used for both chronic rupture greater than 4 weeks following injury and cases of re-rupture.

Surgical treatment is recommended for a chronic Achilles tendon rupture, as well as a re-rupture. Chronic Achilles tendon ruptures are referred to those more than 4 weeks after initial injury. An end-to-end repair is considered insufficient for tendons with a chronic injury or re-rupture and reinforcement is recommended. Fascial reinforcement has n...

Acute Achilles tendon rupture usually occurs in the midportion 2–6 cm proximal from the insertion site of calcaneus. In general there are usually no warning symptoms and the injury frequently occurs with a very distinct ankle trauma. The rupture is generally total and partial Achilles tendon rupture is very rare in the cases of specific pop sensed...

Achilles tendinopathy, defined as the occurrence of pain, swelling and impaired performance, has incidence 0.2% in the general population. However, the incidence is much higher in recreational runners (9%).

Background The optimal treatment for acute Achilles tendon ruptures is still an ongoing debate. Acute ultrasonography (US) investigation to measure the diastasis between the tendon ends has previously been used to classify acute Achilles tendon ruptures; however, no study has used US to predict reruptures and functional outcomes. Purpose To invest...

Purpose To cross-culturally adapt the Achilles tendon Total Rupture Score (ATRS) to Persian language and to preliminary evaluate the reliability and validity of a Persian ATRS. Methods A cross-sectional and prospective cohort study was conducted to translate and cross-culturally adapt the ATRS to Persian language (ATRS-Persian) following steps desc...

The purpose of this study was to evaluate calf muscle endurance in a seated position 3 months after an Achilles tendon rupture and to evaluate how the ability to perform standardized seated heel-rises correlated to the single-leg standing heel-rise test and to patient-reported symptoms evaluated with the Achilles tendon Total Rupture Score (ATRS) 3...

Achilles tendon ruptures are increasingly common, especially in males. The rupture commonly occurs in sports-active persons with a peak age around 40 years. Achilles tendon rupture should be diagnosed clinically, using the well-known Thompson’s and Matles tests. Ultrasonography and Magnetic Resonance Imaging are seldom needed to establish the diagn...

Background: Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women. Purpose: To evaluate whether there are any differences in outcome between the sexes by combining the data from 2 large randomized controlled trials tha...

Bakgrund/syfte: Hälseneruptur drabbar ofta medelålders, fysiskt aktiva kvinnor och män och har ökat de senaste decennierna. Skador i senor läker oftast långsamt och det är inte klarlagt hur rehabiliteringen efter denna skada kan optimeras. Syftet med denna studie var att undersöka vadmuskelns uthållighet i en sittande position och att utvärdera hur...

Abstract Danish Sports Medicine Annual Congress 2015 Title: LONG-TERM FOLLOW UP AFTER ACUTE ACHILLES TENDON RUPTURE Authors: Brorsson A, Silbernagel KG, Eriksson BI, Karlsson J, Helander KN Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sw...

Introduction It is still unknown why many patients never fully recover after an Achilles tendon rupture (ATR). The aim of this study was to perform a long-term follow-up (5-9 years) of patients treated either surgically or non-surgically after an ATR. Furthermore, we wanted to examine if the patients had a tendon elongation on the injured side and...

Achilles tendon rupture occurs relatively common (De Jonge, Br J Sports Med 45:1026–1028, 2011). Although it is the thickest and strongest tendon in the human body, it remains susceptible to injury. During the last decades, the incidence of spontaneous ruptures has been rising, which may be due to the increasing keep-fit culture. Ruptures occur mos...

Objectives: There is an indication in the literature that there is a difference in tendon healing between genders. However comparisons in outcome are often not possible due to the small sample size of women with an acute Achilles tendon rupture. In most studies on patients with Achilles tendon rupture the women only account for less then 20% of the...

Title: Development and evaluation of a new seated heel-rise test to evaluate function during the early stages of rehabilitation after an acute Achilles tendon rupture. Introduction: The early stages of rehabilitation appear to be of great importance for outcome after an Achilles tendon rupture. It is a challenge to evaluate the patients’ calf muscl...

The Achilles tendon Total Rupture Score (ATRS) is a questionnaire designed to evaluate pain, symptoms, function and physical activity after Achilles tendon rupture. The purpose of this study was to translate and culturally adapt the ATRS into Turkish and to determine its reliability and validity. The ATRS was translated into Turkish in accordance w...

Total Achilles tendon ruptures are most common in racket sports, and the incidence in football is low. Most footballers who sustain a total Achilles tendon rupture are recreational players around 40 years of age. This injury also occurs in top-level players, although not frequent. The diagnosis is made by clinical evaluation, and only in few cases...

An acute Achilles tendon rupture is a common sports-related injury in middle-aged men. The diagnosis is always clinical and it is very important that the diagnosis is not missed or delayed. The time period for tendon healing and rehabilitation is long and commonly results in functional deficits. Only half of the patients return to the preinjury lev...

Background: The optimal treatment for acute Achilles tendon ruptures is still a subject of debate. Early loading of the tendon is a factor that has been shown to be beneficial to recovery and to minimize complications. The main outcome of previous studies has been complications such as reruptures and deep infections, without focusing on the functi...

The best treatment of acute Achilles tendon rupture has been discussed for decades. During the past half decade, evidence has increased in favor of nonoperative treatment and dynamic and weightbearing rehabilitation. We hypothesized that the treatment strategies would show great variation and that adherence to evidence-based recommendations would n...

Purpose: The Achilles tendon Total Rupture Score (ATRS) was developed because of the need for a reliable, valid and sensitive instrument to evaluate symptoms and their effects on physical activity in patients following either conservative or surgical management of an Achilles tendon rupture. Prior to using the score in larger randomized trial in a...

Patellar tendinopathy is a common, painful, overuse disorder. Although many different treatment methods have been described, there is no consensus regarding the optimal treatment for this condition. The purpose of this study was to systematically review, summarize, and compare treatments for patellar tendinopathy from published randomized controlle...

The purpose of this prospective randomized controlled study was to evaluate the long-term results after an acute Achilles tendon rupture in patients treated surgically or non-surgically. The focus was to evaluate whether any improvements occurred between the one and 2-year evaluation. Eighty-one patients (67 men, 14 women) with a mean (SD) age of 4...