Achilles insertional tendinopathy may require surgical debridement and tendon reattachment when non-operative treatment fails. Single-row and double-row repairs are used, with biomechanical studies favoring double-row, but clinical evidence of improved outcomes is lacking and costs are higher. This multi-center randomized trial will use the VISA-A score to compare outcomes and inform cost-effective, evidence-based surgical care.
Double-row repairs for Achilles insertional tendinopathy have been shown biomechanically to be stronger than single-row repairs, but clinical studies have not demonstrated clear advantages. Existing comparative studies are limited by retrospective designs and use of non-validated outcome measures such as AOFAS, VAS, and SF-36 Physical Function. No prospective randomized trials have evaluated clinical outcomes of single-row versus double-row repairs. This multi-center randomized controlled trial will use the disease-specific Victorian Institute of Sports Assessment-Achilles (VISA-A) score to compare clinical outcomes between single-row and double-row repairs, providing high-quality evidence to guide optimal surgical management.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
166
single-row (2 anchors)
double-row (4 anchors)
Women's College Hospital
Toronto, Ontario, Canada
Disease-specific outcomes
The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated, self-reported outcome measure designed to assess the severity of Achilles tendinopathy. It evaluates three key domains: pain, function, and activity level and produces a score from 0 to 100, with higher scores indicating better function and fewer symptoms.
Time frame: 24 months after surgery
Surgical Cost
Assess the cost difference between single-row repair versus double-row repair
Time frame: Within 2 hours of surgery
Foot and Ankle Ability Measure (FAAM)
The FAAM is a patient-reported outcome questionnaire designed to assess physical function in individuals with foot and ankle disorders. Scores are typically expressed as percentages, with higher scores indicating better function.
Time frame: 24 months after surgery
Visual Analogue Scale Foot and ankle (VAS-FA)
The VAS-FA is a patient-reported outcome measure designed to assess pain, function, and other symptoms related to foot and ankle disorders. It uses a visual analogue scale, typically a 100 mm line, where patients indicate the severity of their symptoms. Higher scores usually indicate better function or less pain.
Time frame: 24 months after surgery
Plantarflexion strength
Measured using a HUMAC Norm Isokinetic Dynamometer Weakness: May indicate calf muscle atrophy, nerve injury, or Achilles tendon dysfunction. Deficits: Can cause altered gait, decreased push-off, and balance problems.
Time frame: 24 months after surgery
Biomechanical performance
Including ankle kinematics and kinetics during gait and functional tasks, assessed through markerless motion tracking. Gait Analysis: Evaluating walking or running patterns in patients with musculoskeletal or neurological impairments.
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Time frame: 24 months after surgery
Functional endurance
As measured by the Heel Rise Test Normal: Able to perform ≥25-30 single-leg heel raises with minimal fatigue. Weakness: Fewer repetitions or lower heel height may suggest calf muscle weakness.
Time frame: 24 months after surgery
Surgical Time
Assess the operative time required for single-row repair versus double-row repair.
Time frame: During surgery