Delmastro Elena, Colace Stefano, Longo Umile Giuseppe, D'Hooghe Pieter, Marangon Alberto, Galasso Olimpio, Gasparini Giorgio, Mercurio Michele
Orthopaedic and Trauma Department, Università Vita-Salute San Raffaele, 20132 Milano, Italy.
Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy.
Medicina (Kaunas). 2025 Sep 17;61(9):1684. doi: 10.3390/medicina61091684.
: Achilles tendon ruptures in middle-aged individuals with systemic comorbidities represent a growing clinical challenge. Revision surgery, indicated in cases of tendon re-rupture, remains technically demanding and lacks standardized treatment protocols. This comprehensive review aimed to summarize current evidence regarding indications, outcomes, and complications associated with the most commonly employed revision techniques and explores the potential of artificial intelligence (AI) in improving management and outcomes. : A literature review was performed in accordance with PRISMA guidelines. The PubMed, MEDLINE, and Cochrane Central databases were used to search keywords. We included articles (1) reporting indications, outcomes, and/or complications of revision surgery for Achilles tendon rupture; (2) reporting a minimum mean follow-up of >12 months; and (3) written in English. Six studies met the inclusion criteria, with a total of 3250 patients analyzed. A methodological quality assessment using the Modified Newcastle-Ottawa Quality Assessment Scale was performed, and all articles were found to be of high quality. : Surgical strategies were stratified based on defect size: <2 cm: end-to-end anastomosis; 2-5 cm: V-Y myotendinous lengthening, often combined with tendon transfer; and >5 cm: fascial turndown flaps, autografts (e.g., semitendinosus), or allografts. Tendon transfers showed satisfactory functional outcomes but varied in complication rates. Allografts offered reduced donor site morbidity. The use of AI and wearable sensors has demonstrated potential in preoperative planning, complication prediction, and real-time rehabilitation monitoring. : Achilles tendon revision surgery requires a patient-specific, defect-oriented approach. Combined surgical techniques are often necessary for large or non-viable lesions. The integration of AI represents a promising advancement in enhancing surgical decision-making, optimizing rehabilitation, and improving long-term clinical outcomes.
中年合并全身性疾病患者的跟腱断裂是一个日益严峻的临床挑战。对于肌腱再次断裂的病例，翻修手术技术要求高且缺乏标准化治疗方案。本综述旨在总结当前关于最常用翻修技术的适应证、疗效及并发症的证据，并探讨人工智能（AI）在改善治疗管理和疗效方面的潜力。
按照PRISMA指南进行文献综述。使用PubMed、MEDLINE和Cochrane Central数据库检索关键词。纳入的文章需满足以下条件：（1）报告跟腱断裂翻修手术的适应证、疗效及/或并发症；（2）报告的平均随访时间至少>12个月；（3）英文撰写。六项研究符合纳入标准，共分析3250例患者。使用改良的纽卡斯尔-渥太华质量评估量表进行方法学质量评估，所有文章均为高质量。
<2 cm：端端吻合；2 - 5 cm：V - Y肌腱延长术，常联合肌腱转移术；>5 cm：筋膜翻转皮瓣、自体移植物（如半腱肌）或异体移植物。肌腱转移术功能疗效满意，但并发症发生率各异。异体移植物可降低供区发病率。人工智能和可穿戴传感器的应用在术前规划、并发症预测及实时康复监测方面已显示出潜力。
跟腱翻修手术需要针对患者个体、以缺损为导向的方法。对于大的或无活力的损伤，联合手术技术通常是必要的。人工智能的整合在增强手术决策、优化康复及改善长期临床疗效方面是一个有前景的进展。
