The Achilles tendon is the strongest and largest tendon in the body, but it is also the most commonly ruptured tendon. The overall incidence of Achilles tendon rupture is on the rise recently 1,2) because of the aging of the population, growing prevalence of obesity, and increased participation in sports. 3) Controversy has surrounded the optimal treatment of acute Achilles tendon rupture. 4) In the past, aggressive surgical intervention was recommended over conservative management on the basis of early studies that associated conservative treatment with high rerupture rates. [5][6][7][8] These studies provided a rationale for operative treatment of acute rupture of the Achilles tendon, despite the risk of complications from surgery such as wound infection. However, recent studies have demonstrated favorable outcomes of conservative treatment using accelerated functional rehabilitation. In such studies, functional rehabilitation was more effective in reducing rerupture rates than long-term cast immobilization, and functional improvement after nonoperative treatment was comparable to that after operative repair. [9][10][11] Currently, regardless of the treatment modality-either conservative or opera-tive-used, aggressive early rehabilitation is advocated for acute Achilles tendon ruptures to allow for an early return to activities of daily living, high patient satisfaction, and functional improvement. In this review article, we provide a comprehensive review of the literature on acute rupture of the Achilles tendon and discuss appropriate treatment options. EPIDEMIOLOGYAchilles tendon rupture accounts for 20% of all large tendon ruptures. 12) The estimated incidence ranges from 11 to 37 per 100,000 population. [13][14][15] Men are 2 to 12 times more prone to Achilles tendon rupture than women. 16) In a 2012 meta-analysis by Soroceanu et al., 10) the mean age at the time of injury among 826 patients with an acute Achilles tendon rupture was 39.8 years. The injury has a bimodal age distribution with the first peak in patients between 25 years and 40 years of age and the second peak in those over 60 years. 17,18) High-energy injuries in sports are responsible for the first peak, whereas the second peak occurring in the elderly is mostly associated with low-energy injuries, such as spontaneous rupture of the degenerated Achilles tendon or rupture in chronic Achilles tendinopathy. In young patients with acute sports injures, conservative management is usually sufficient for tendon healing. However, rupture of the degenerated tendon in the elderly requires a different treatment approach because the tendon remains vulnerable to rerupture even after operative

BackgroundSeveral 3D multi-segment foot models (MFMs) have been introduced for the in vivo analysis of dynamic foot kinematics. However, reproducibility of a model should be checked and ascertained before clinical utilization of a MFM. The purpose of this study was to determine the reliability of recently introduced MFM with a 15-marker set by assessing the participant’s stride-to-stride (intra-session) and visit-to-revisit (inter-session) repeatability.MethodsTwenty healthy adults with a mean age of 28.9 years (10 males and 10 females) were tested. Three representative strides from five separate trials were used for analysis from each session. Kinematic data of foot segmental motion was collected and tracked using the Foot3D Multi-Segment Software (Motion Analysis Co., Santa Rosa. CA). A retest was performed in the same manner at an interval of 4 weeks. Coefficients of multiple correlation (CMC) and intra-class correlation coefficient (ICC) were calculated in order to assess the intra-session and inter-session repeatability.ResultsInter-segment foot angles from healthy adults from a MFM with 15-marker set showed a narrow range of variability during the gait cycle. The mean intra-session ICC was 0.981 (±0.010), which was interpreted as excellent. The mean intra-session CMC was 0.948 (±0.027), which was interpreted as very good repeatability. The mean inter-session ICC was 0.886 (±0.047) and the mean inter-session CMC was 0.801 (±0.077), which were interpreted as excellent and good repeatability, respectively.ConclusionWe demonstrated a MFM with a 15-marker set had high intra-session and inter-session repeatability, especially in sagittal plane motion. We thought this MFM would be applicable to evaluation of the segmental foot motion during gait.

BackgroundThis study was undertaken to investigate the trends of orthopedic publications during the last decade, and to document the country of origin, journal, funding source, and language of contribution using PubMed.MethodsOrthopedic articles published between 2000 and 2009 were retrieved from PubMed using the following search terms: "orthopaedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])" and "orthopedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])." The articles were downloaded in XML file format, which contained the following information: article title, author names, journal names, publication dates, article types, languages, authors' affiliations and funding sources. These information was extracted, sorted, and rearranged using the database's management software. We investigated the annual number of published orthopedic articles worldwide and the annual rate of increase. Furthermore, the country of publication origin, journal, funding source, and language of contribution were also investigated.ResultsA total of 46,322 orthopedic articles were published and registered in PubMed in the last 10 years. The worldwide number of published orthopedic articles increased from 2,889 in 2000 to 6,909 in 2009, showing an annual increase of 384.6 articles, or an annualized compound rate of 10.2%. The United States ranked highest in the number of published orthopedic articles, followed by Japan, the United Kingdom, Germany, and the Republic of Korea. Among the orthopedic articles published worldwide during the last 10 years, 37.9% pertained studies performed in the United States. Fifty-seven point three percent (57.3%) of articles were published in journals established in the United States. Among the published orthopaedic articles, 4,747 articles (10.2%) disclosed financial support by research funds, of which 4,688 (98.8%) articles utilized research funds from the United States. Most articles were published in English (97.2%, 45,030 articles).ConclusionsThe number of published orthopedic articles has been increasing over the last decade. The number of orthopedic articles, journals publication, and funding sources were dominated by research conducted in the United States, while share and growth of Asian countries including Japan, the Republic of Korea, and China were notable.