British medical bulletin最新文献

{"title":"Clinical predictors of type II endoleaks after EVAR: a systematic review of risk and protective factors.","authors":"Giulia Colonna, Chiara Fasulo, Mario Antonelli, Anna Santini, Costanza Morucci, Ginevra Mazzetti, Luigi Rizzo, Maurizio Taurino, Pasqualino Sirignano","doi":"10.1093/bmb/ldag035","DOIUrl":"https://doi.org/10.1093/bmb/ldag035","url":null,"abstract":"<p><strong>Introduction: </strong>The present systematic review seeks to examine clinical factors potentially associated with endovascular aortic aneurysm repair (EVAR) failure due to type II endoleaks (TIIEL).</p><p><strong>Source of data: </strong>Relevant literature was sourced from PubMed, including all studies regarding clinical features possibly linked to TIIEL, written in English. Studies focused on anatomical predictors, case reports, and abstracts were excluded. The literature search used keywords related to clinical characteristics, comorbidities, and demographics common in EVAR patients.</p><p><strong>Areas of agreement: </strong>EVAR is the preferred treatment for abdominal aortic aneurysms in eligible patients. The most common complication is endoleak (persistent filling of the sac). TIIEL is caused by retrograde blood flow from aortic side branches and is the most frequent complication, occurring in 16%-50% of cases.</p><p><strong>Areas of controversy: </strong>Many studies have explored anatomical predictors of TIIEL, but limited research is available on clinical factors that may contribute to its occurrence.</p><p><strong>Growing points: </strong>Protective factors against TIIEL included statin therapy, salicylate therapy, smoking, ankle/brachial systolic blood pressure index <0.87, and chronic obstructive pulmonary disease. Conversely, anticoagulation therapy, inflammatory status, and advanced age were associated with an increased risk of TIIEL.</p><p><strong>Areas timely for developing research: </strong>Further prospective research is needed to validate the presented association between clinical factors and EVAR failure due to TIIEL, to allow risk stratification and tailored follow-up strategies for selected groups of patients.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor site morbidity after autologous bone graft harvesting for fracture nonunion: a systematic review and comparative analysis of four techniques.","authors":"Grayson Norris, Sean Young, Bryce Sanchez, Joshua Major, Nicholas Pettinelli, Brent Norris","doi":"10.1093/bmb/ldag038","DOIUrl":"https://doi.org/10.1093/bmb/ldag038","url":null,"abstract":"<p><strong>Introduction: </strong>Autologous bone grafting is the reference standard for fracture nonunion; however, donor site morbidity remains a primary concern across all harvesting techniques.</p><p><strong>Sources of data: </strong>A systematic search of PubMed and Embase was performed from January 2011 to March 2026, chosen to capture the 15-year period since the landmark 2011 review of autograft harvest complications by Dimitriou et al., in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 49 studies comprising 3029 graft sites across four autograft harvesting techniques were included.</p><p><strong>Areas of agreement: </strong>Complication profiles are highly technique-dependent. ICBG demonstrated the lowest overall complication rate (5.83%). Fibular strut grafts demonstrated similarly favourable morbidity (4.88%). Significant differences in overall complication rates were identified between ICBG and reamer-irrigator-aspirator (RIA) (P = .0008) and between ICBG and PK (P < .0001).</p><p><strong>Areas of controversy: </strong>RIA has historically been considered lower morbidity than ICBG; however, the present analysis demonstrated a higher overall complication rate for RIA (9.40%), driven primarily by transfusion requirements (7.88%). This finding likely reflects broader use of RIA in more complex nonunion presentations and improved recognition of transfusion-related risk.</p><p><strong>Growing points: </strong>Periarticular knee harvesting demonstrated the highest overall complication rate (13.64%), challenging its perception as a uniformly low-morbidity technique. Future studies with larger per-subtype cohorts are needed to compare these independently.</p><p><strong>Areas for developing research: </strong>Prospective, multicentre cohort studies employing standardized complication definitions and adequate follow-up durations are needed to overcome the heterogeneity inherent to the current retrospective literature.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo animal models of Achilles tendon rupture management: a narrative review.","authors":"Nicola Maffulli, Filippo Spiezia, Francesco Oliva","doi":"10.1093/bmb/ldag032","DOIUrl":"https://doi.org/10.1093/bmb/ldag032","url":null,"abstract":"<p><strong>Introduction: </strong>Acute Achilles tendon rupture is common, and the balance between surgical and non-surgical management remains contested. Much of the mechanistic evidence informing this debate derives from in vivo animal models, which have not previously been appraised together as a class.</p><p><strong>Sources of data: </strong>PubMed/MEDLINE was searched using terms for the Achilles/calcaneal tendon combined with terms for rupture, transection, tenotomy, defect, repair and relevant animal species. Reference lists of included studies and pertinent reviews were hand-searched, supplemented by a grey-literature/web sweep. The search was last updated in June 2026. Given the marked heterogeneity of species, injury model, intervention and outcome measures, findings are synthesized narratively rather than pooled quantitatively or scored against a structured risk-of-bias instrument.</p><p><strong>Areas of agreement: </strong>Twenty-four in vivo studies (predominantly rat, with mouse, rabbit and one sheep model) were identified. Immobilization angle and duration, rather than repair per se, appear to be dominant determinants of early healing. Biological and pharmacological augmentation strategies generally improve biomechanical properties, with less consistent histological change.</p><p><strong>Areas of controversy: </strong>Controversies in this literature are of two kinds, substantive and methodological. Direct comparisons of repair versus non-repair are scarce, and reach divergent conclusions once immobilization is accounted for. Reporting of randomization, allocation concealment, blinding and sample-size justification is inconsistent and often absent.</p><p><strong>Growing points: </strong>Cell- and vesicle-based therapies, engineered scaffolds and lineage-tracing/mechanistic models are actively reshaping this literature.</p><p><strong>Areas timely for developing research: </strong>Consensus reference models with standardized transection, repair and immobilization protocols, explicit reporting of ankle angle, duration and method of immobilization, weight-bearing status and timing of mobilization, ARRIVE-compliant reporting, and embedding of biological augmentation within defined management models are needed to strengthen translational value.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive assessment of the anaerobic threshold in endurance athletes: an evidence-based narrative review of methods, validity, and field feasibility.","authors":"Nicola Maffulli, Johnny Padulo, Francesco Oliva","doi":"10.1093/bmb/ldag037","DOIUrl":"10.1093/bmb/ldag037","url":null,"abstract":"<p><strong>Introduction or background: </strong>The anaerobic threshold (AnT) marks the transition between heavy and severe exercise intensity domains and guides training prescription and performance monitoring. Criterion methods (blood lactate and gas exchange) are accurate but invasive, costly, or impractical outside laboratories, prompting the search for noninvasive surrogates. This review evaluates the validity of these estimation procedures rather than the underlying physiology.</p><p><strong>Sources of data: </strong>MEDLINE (via PubMed) was searched from inception without language restrictions, supplemented by reference-list and citation searching. Eligible studies compared noninvasive AnT indices, including heart rate variability (HRV; including detrended fluctuation analysis [DFA] α1), cardiac repolarization instability, heart rate deflection/field slope-variation methods, critical power (CP)/ critical speed (CS), near-infrared spectroscopy (NIRS), the talk test, and machine-learning (ML) models, with criterion standards. Risk of bias was assessed using QUADAS-2. Eighty-eight reports were synthesized narratively; no meta-analysis was performed.</p><p><strong>Areas of agreement: </strong>DFA α1, NIRS breakpoints, and CP/CS show strong associations with laboratory criteria and increasing field applicability through wearables. Accuracy and feasibility trade-offs require method selection according to the threshold, sport, and required precision.</p><p><strong>Areas of controversy: </strong>Correlation indicates group-level association rather than individual agreement; Bland-Altman and reliability analyses are more informative for substitution. Criterion standards are not interchangeable, and heart rate deflection is not consistently identifiable. Evidence in female athletes remains limited.</p><p><strong>Growing points: </strong>Multimodal wearables integrating HRV, muscle oxygenation, and running power with ML may improve field-based threshold estimation.</p><p><strong>Areas for developing research: </strong>Priorities include standardized reporting, transparent bias assessment, female-athlete validation, and broader systematic and meta-analytic synthesis.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Popliteal artery entrapment syndrome. Current concepts, dilemmas, and challenges.","authors":"Laura Calsina-Juscafresa, Albert Clarà, Pedro Hinarejos, Oscar Gasulla, Salvatore Marsico, Joan Carles Monllau","doi":"10.1093/bmb/ldag034","DOIUrl":"https://doi.org/10.1093/bmb/ldag034","url":null,"abstract":"<p><strong>Introduction: </strong>Popliteal artery entrapment syndrome (PAES) results from extrinsic compression of the popliteal artery as it passes through the popliteal fossa due to congenital musculotendinous anomalies or acquired muscle hypertrophy. The consequence of this compression is a progressive damage to the arterial wall, which can ultimately cause irreversible injury. This damage initially manifests as intermittent claudication, which usually occurs in young, athletic individuals with no cardiovascular risk factors. There may be an overlap of symptoms with other conditions, making diagnosis challenging. Beyond clinical suspicion, dynamic tests with provocation manoeuvres are essential. Early decompression treatment of symptomatic cases can prevent the onset of potentially serious complications, including amputation.</p><p><strong>Sources of data: </strong>This review integrates evidence from peer-reviewed literature focusing on popliteal entrapment syndrome.</p><p><strong>Areas of agreement: </strong>Shortening the timeline from diagnosis to referral can help prevent irreversible damage to the arteries.There are a significant number of publications on PAES, based on retrospective single-centre experiences, short series or case reports, and limited scientific evidence. All publications repeatedly conclude that prospective multicentre studies are needed to standardize diagnostic and therapeutic protocols and develop guidelines for PAES.</p><p><strong>Areas of controversy: </strong>There are many points of disagreement regarding the management of PAES, and this does not help in addressing two key issues: avoiding misdiagnosis and unnecessary surgeries, which promote delayed diagnosis in worse clinical conditions.</p><p><strong>Growing points: </strong>The creation of multicentre working groups seems necessary due to the limited number of cases at individual centres for conducting prospective studies.</p><p><strong>Areas timely for developing research: </strong>Creation of international consensus protocols on definition, diagnosis, and treatment of PAES.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sports participation on genu varum among youth: a systematic review.","authors":"Ali Işın, Eren Akdağ, Burhan Demirkıran, Dennis Caine","doi":"10.1093/bmb/ldag033","DOIUrl":"10.1093/bmb/ldag033","url":null,"abstract":"<p><strong>Introduction: </strong>Genu varum occurs more frequently among young male athletes involved in high levels of physical activity, particularly adolescent male soccer players when compared to the general population. This study provides a contemporary examination of the relationship between genu varum and participation in youth sport.</p><p><strong>Sources of data: </strong>A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The literature search was conducted in Web of Science, Scopus, PubMed, Embase, and CINAHL databases.</p><p><strong>Areas of agreement: </strong>Genu varum is more prevalent among athletes than among age-matched non-athlete controls and has been reported more often in male soccer players, with overloading of the proximal medial tibial growth plate proposed as a possible contributing mechanism.</p><p><strong>Areas of controversy: </strong>Intercondylar-intermalleolar distance differed in younger age groups with some reporting negative values and some reporting positive values.</p><p><strong>Growing points: </strong>In recent years, there has been a marked improvement in the methods used to assess lower limb malalignment in young athletes. Clinical measures are simple but lack detail; whole-leg radiographs are increasingly used to capture these details.</p><p><strong>Areas timely for developing research: </strong>The lack of longitudinal data examining changes in lower extremity alignment with sports loading during the growth period is an important deficiency of the current research. Long-term follow-up studies are needed to clarify the nature and incidence of genu varum in young athletes, including females. Furthermore, the relationship between genu varum and non-soccer sports should be investigated so the movement and loading characteristics specific to different sports need to be evaluated.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"160 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic susceptibility to aseptic loosening following total hip and knee arthroplasty: a systematic review of candidate-gene and genome-wide association studies.","authors":"Nicola Maffulli, Filippo Spiezia, Angelo Del Buono, Francesco Oliva","doi":"10.1093/bmb/ldag025","DOIUrl":"10.1093/bmb/ldag025","url":null,"abstract":"<p><strong>Introduction: </strong>Aseptic loosening is the leading cause of revision after total hip (THA) and knee (TKA) arthroplasty, accounting for 33%-50% of revisions. Variable individual susceptibility suggests genetic contributions.</p><p><strong>Sources of data: </strong>Five databases searched to 9 June 2026. Studies reporting genetic associations with aseptic loosening or osteolysis in THA/TKA were included. Quality was assessed via Q-Genie. Pooled odds ratios (random-effects) were computed for loci with ≥3 independent studies (TNF-α -308G > A, IL-6 -174G > C). Meta-analysis for MMP-1 rs5854 was not possible because of insufficient replication.</p><p><strong>Areas of agreement: </strong>Twenty-six studies (7419 participants) examined THA or mixed cohorts; none studied TKA alone. Seventeen gene loci were implicated (cytokines, bone remodelling, matrix degradation, etc.). Pooled analysis: TNF-α -308G > A OR 1.94 (95% CI 1.28-2.93; I2 = 38%; 3 studies); IL-6 -174G > C OR 1.61 (95% CI 1.07-2.42; I2 = 51%; 3 studies). IL-1RN VNTR 498 bp allele conferred ~ 4-fold risk in atopic patients. Variants in RANK, KREMEN2, OPG, SFRP1, TIRAP, and BCL2 were also associated. GNAS1 and CALCA showed no association. Quality was low to moderate. No genome wide association studies (GWAS) was identified.</p><p><strong>Areas of controversy: </strong>Evidence is dominated by small, single-centre, candidate-gene studies in Caucasian THA cohorts, with heterogeneity in surgery, implants, and phenotype definitions.</p><p><strong>Growing points: </strong>IL1RN-atopy interaction enables pre-surgical screening. IL-6 genotyping may personalize monitoring. Biobank-registry linkage now permits adequately powered GWAS.</p><p><strong>Areas timely for developing research: </strong>A well-powered GWAS using registry-biobank linkage; independent replication of RANK/OPG/Wnt and IL1RN findings; first TKA-specific genetic studies; standardized phenotype definitions.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrogel: synthesis, physicochemical properties, and medical uses.","authors":"Kosar Moodi, Ahmad Oryan, Esmat Alemzadeh, Nicola Maffulli","doi":"10.1093/bmb/ldag029","DOIUrl":"10.1093/bmb/ldag029","url":null,"abstract":"<p><strong>Introduction or background: </strong>Hydrogels are three-dimensional polymeric networks capable of absorbing substantial amounts of water while maintaining structural stability. In the biomedical field, hydrogels are widely used because of their high water content, flexibility, and the ability to be chemically modified for diverse applications. Their biocompatibility, biodegradability, porosity, and environmental sensitivity enable them to mimic the extracellular matrix, supporting cell growth and tissue regeneration.</p><p><strong>Sources of data: </strong>This review integrates information from existing studies, classifying hydrogels based on their molecular origin, and analyses various reports on their synthesis methods, mechanical properties, and biomedical applications.</p><p><strong>Areas of agreement: </strong>Hydrogels (natural, synthetic, and hybrid) exhibit different mechanical properties, bioactivity levels, and degradation patterns. Functional hydrogels with self-healing, injectable, and stimulus-responsive properties have significantly improved drug delivery and therapeutic performance.</p><p><strong>Areas of controversy: </strong>Although a standardized framework to evaluate different hydrogel types exists, it remains incomplete. The lack of universally accepted classification criteria and inconsistencies in performance evaluation across studies continue to pose challenges the field.</p><p><strong>Growing points: </strong>Recent advances in molecular design have led to produce protein/peptide-based, polysaccharide-based, DNA-based, and synthetic hydrogels. These developments highlight the growing importance of integrating molecular-level design with application-driven functionalities.</p><p><strong>Areas timely for developing research: </strong>Future research should focus on refining hydrogel classification systems, standardizing evaluation methodologies, and exploring multifunctional, responsive hydrogel systems tailored to advanced biomedical applications such as precision drug delivery, tissue engineering, and regenerative medicine.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physeal stress injury and osteochondrosis in the ankle and foot of young athletes.","authors":"Laura Purcell, Kelly Ainsworth, Dennis Caine, Jie C Nguyen","doi":"10.1093/bmb/ldag026","DOIUrl":"10.1093/bmb/ldag026","url":null,"abstract":"<p><strong>Background: </strong>Epiphyseal physeal stress injuries (PSIs) and osteochondroses of the foot and ankle in pediatric athletes can result in prolonged absence from activities, surgical intervention or growth arrest, and/or alignment deformities.</p><p><strong>Sources of data: </strong>A systematic review was performed using PRISMA guidelines. Medline, EMBASE and CINAHL electronic databases were searched to identify articles. Clinical studies evaluating the diagnosis and outcomes of PSIs and osteochondrosis of the foot and ankle in pediatric athletes were included.</p><p><strong>Areas of agreement: </strong>PSIs and osteochondrosis of the foot and ankle require imaging diagnosis often involve the use of radiographs and/or MRI. Conservative treatment is often the initial approach to managing these injuries. These injuries can result in prolonged absence from activity.</p><p><strong>Areas of controversy: </strong>For injuries that do not resolve with conservative treatment, surgery is often the next step. The timing and type of procedure is variable.</p><p><strong>Growing points: </strong>Early findings of PSIs or osteochondroses of the foot and ankle may be subtle or inconspicuous on initial radiographs and may require additional imaging workup to ensure appropriate diagnosis. Delayed diagnosis may result in prolonged symptoms and absence from activity and possibly result in growth disturbances.</p><p><strong>Areas timely for developing research: </strong>Injury surveillance in all youth sports and activities must include screening for PSIs and osteochondroses to ensure better documentation of incidence among youth. Well-planned prospective longitudinal epidemiological and imaging studies are required to provide more accurate data on the occurrence and natural history of these injuries.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous repair of acute Achilles tendon tears with minimally invasive augmentation with the tendon of flexor hallucis longus: a 5 years outcome study.","authors":"Nicola Maffulli, Filippo Migliorini, Francesco Oliva, Gayle Maffulli, Filippo Spiezia","doi":"10.1093/bmb/ldag018","DOIUrl":"10.1093/bmb/ldag018","url":null,"abstract":"<p><strong>Background: </strong>Even after surgical repair, acute Achilles tendon rupture (ATR) may leave residual strength and function deficits. Augmenting percutaneous repair with the flexor hallucis longus (FHL) tendon may limit elongation and reinforce the repair. We report 5-year outcomes of acute ATR managed with percutaneous repair alone or with minimally invasive FHL augmentation.</p><p><strong>Sources of data: </strong>A prospective comparative cohort of 53 patients (27 percutaneous repair alone, 26 with FHL augmentation) with a minimum 5 years follow-up. Objective and subjective outcomes were collected.</p><p><strong>Areas of agreement: </strong>At 5 years, both procedures gave equivalent results on all patient-reported outcome measures. FHL augmentation reduced tendon elongation (lower Achilles tendon Resting Angle) and produced statistically significantly greater isometric strength and smaller calf circumference difference.</p><p><strong>Areas of controversy: </strong>Structural and strength differences were small, of doubtful clinical relevance, and did not improve patient-reported function. FHL augmentation is more demanding, longer, costlier, and required inpatient admission, whereas percutaneous repair was a day-case procedure under local anesthesia. A significant between-group age difference is an important confounder.</p><p><strong>Growing points: </strong>Structural indices frequently dissociate from patient-reported function after ATR. Within the Italian National Health Service, the added resource use of FHL augmentation is hard to justify when no validated measure detects a clinically meaningful 5-year difference.</p><p><strong>Areas timely for developing research: </strong>Adequately powered randomized trials with pre-specified age stratification are needed to establish whether particular subgroups, such as older patients or those with more degenerate tendons, derive a clinically relevant benefit from FHL augmentation.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}