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Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.

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Background The aim of the study is to investigate the differences between the extensile lateral (EL) and sinus tarsi (ST) approaches for the treatment of displaced intra-articular calcaneus fractures as treated by a single surgeon. Methods A retrospective cohort study performed at a Level 1 trauma center. One hundred twenty-nine consecutive intra-articular calcaneus fractures from 2011 to 2018 that were surgically treated by a single surgeon. Primary outcomes were time to surgery, operative time, postoperative restoration of the critical angle of Gissane, postoperative wound complications, and need for unplanned re-operation. Results Patient characteristics, including demographics, mechanism of injury, and fracture patterns were similar between the EL and ST approach groups. There was a significant decrease in unplanned secondary procedures (P = .008), shorter time to definitive fixation (P = .00001), and shorter average operative time in the ST group (P = .00001). Postoperative measurement of the critical angle of Gissane between the two groups was significantly different, but minute with an average difference of approximately 3 degrees (P = .025). Measurements in both groups were within the expected range of normal. Conclusions For displaced intra-articular calcaneus fractures, a limited open ST approach is associated with a significant reduction in the time to definitive fixation and decreased operative time. The EL approach was associated with a small, but significant improvement in the restoration of the critical angle of Gissane compared with the ST approach. Therefore, an ST approach may allow for earlier surgical intervention and result in equivalent quality of reduction compared with an EL approach. Level of Evidence: Level III

Periprosthetic fracture after hindfoot fusion nailing is a complex, uncommon complication. There is no consensus in the literature regarding optimal treatment of these injures, with proposed solutions, including cast immobilization, retrograde femoral and humeral nails, circular external fixation, and amputation. The goal of revision surgery is to adequately bypass and stabilize the fracture, protect the hindfoot fusion site from increased stress, and promote early weight bearing in a load-sharing fashion. In this report, we present the case of an unstable periprosthetic tibia fracture involving the proximal aspect of a hindfoot fusion nail 10 weeks after surgery in the setting of an incompletely fused hindfoot. The patient was successfully treated using a spanning antegrade suprapatellar tibia nail extending from the proximal aspect of the tibia to the plantar aspect of the calcaneus to bypass the tibia fracture as well as protect and maintain fixation across the hindfoot fusion. At final follow-up, the patient had union across her tibia fracture as well as her hindfoot fusion and was able to return to her activities of daily living and ambulate in normal shoe wear. Level of Evidence: Level V