The use of biologic therapies for the management of knee osteoarthritis (OA) has largely increased in recent years. The purpose of this study was to evaluate the efficiency and the therapeutic potential of platelet-rich plasma (PRP) and autologous adipose tissue (AAT) injections as a treatment for knee OA. Sixty participants were enrolled in the study: 20 healthy ones and 40 with minimal to moderate knee OA (KL I-III). The OA patients were randomly assigned either to the PRP or to the AAT group. The PRP samples showed a low expression level of NF-κB-responsive gene CCL5 and high expression levels of classic inflammatory and TNF-l INF responses. The AAT injection product was prepared using a Lipogems device, and its regenerative potential as well as the ability for expansion of mesenchymal stem cells were tested in the cell culture conditions. The patient assessments were carried out five times. Significant improvement was observed regardless of the treatment method in the VAS, KOOS, WOMAC and IKDC 2000 subjective evaluations as well as in the functional parameters. Intra-articular injections of AAT or PRP improved pain, symptoms, quality of life and functional capacity with a comparable effectiveness in the patients with mild to moderate knee osteoarthritis.

Background and objectives: The Achilles tendon, the largest tendon in the body, is vulnerable to injury because of its limited blood supply and the combination of forces to which it is subjected. Given the relevance of the Achilles tendon in the proper function of the foot and ankle, the primary goal of the present study was to use a holistic approach for a comprehensive evaluation of Achilles tendon reconstruction results on multiple levels. Materials and Methods: The study was designed in the following way: 30 patients with partial or total Achilles tendon tears were subjected to the minimally invasive Achilles tendon reconstruction. Patients were then subjected to the clinical, functional and isokinetic tests 12 and 24 months after the treatment. The clinical evaluation included calf circumference measurements and subjective patient-reported tests: ATRS, EQ-5D-5L and VAS scales. The functional evaluation was based on three tests: the weight-bearing lunge test, the heel rise test and single leg hop. Isometric and isokinetic evaluation was performed using a Biodex 3 dynamometer. Results: The calf circumference of the operated limbs was significantly lower than the non-operated limb 12 months after the surgical procedure, however this improved at the second evaluation. All subjective outcomes improved significantly 24 months after the surgery. Significantly better results in the function of the operated limbs were also obtained 24 months after the surgery. However, most of the muscle strength parameters of the operated limbs were already comparable to non-operated ones 12 months after the surgery and were comparable between two evaluation times. Conclusions: The overall results of this extensive evaluation are highly satisfactory and patients returned to their normal physical activity. From a medical point of view, it is assumed that the healing process is completed 12 months after the surgery, however, importantly, our results indicate that we should consider the healing process and the rehabilitation process separately.

Introduction One of the treatment options in chronic damage or unsuccessful suturing of the Achilles tendon is a surgical treatment consisting of its reconstruction using the tendon of semitendinosus and gracilis muscle. The multitude of types of reconstruction causes discrepancies in rehabilitation protocols. All of them aim to return to full functional fitness as the ultimate goal. Aim This study aims to present the proprietary rehabilitation protocol after Achilles tendon reconstruction using the tendon of semitendinosus and gracilis muscle. Material and methods The presented rehabilitation program lasts about 12 months and is divided into six stages. Stage I consists of standing up and anticoagulant exercises, and isometric exercise. Stage II, lasting up to 2 weeks after the procedure, consists of the patient’s independent work in the home environment. Stage III, lasting up to 4 weeks, involves learning to walk and putting weight on the limb in a cam Walker. In the third stage, after the postoperative wounds have healed, exercises in water conditions are started. Stage IV, lasting from 4 weeks after the operation, involves loading the limb with support, increasing the range of dorsiflexion motion, and progressive muscle strengthening. Stage V, which lasts up to 8–12 months after surgery, eliminates functional deficits and prepares the patient for a functional biomechanical assessment. Stage VI is the stage of work on the compensation of deficits resulting from the analysis of the results of the functional biomechanical assessment necessary to return to the full sports activity. Results The rehabilitation time, in accordance with the assumptions of the above protocol, is 8–12 months. After this time, the patient should proceed to a functional biomechanical assessment. Discussion and conclusions The rehabilitation protocol presented by our team describes in detail the stages of post-operative rehabilitation after Achilles tendon reconstruction with a hamstring graft. It provides the conditions necessary for the patient to meet before starting the next phase and returning to sport. Our requirements are consistent with the assumptions available in the scientific base. Keywords: Achilles tendon reconstruction, return to sport, rehabilitation program.

Background: The Achilles tendon is prone to rupture, particularly in middle-aged men, and chronic injuries are often due to missed diagnoses or inadequate treatment. While acute ruptures can be managed with primary repair, chronic cases with tendon gaps >3 cm require reconstruction. A minimally invasive technique using autologous semitendinosus and gracilis tendon grafts has previously shown favorable short-term outcomes. This study evaluates longer-term outcomes with a minimum 5-year follow-up. Methods: This study analyzed 21 patients undergoing minimally invasive Achilles tendon reconstruction with autologous hamstring grafts, compared with 21 healthy controls. magnetic resonance imaging confirmed diagnoses, and surgeries (2016–2019) used the EndoButton system for graft stabilization. Assessments included Achilles tendon Total Rupture Score (ATRS) for patient-reported outcomes, EuroQoL–5 Dimensions, 5 Levels (EQ-5D-5L) for overall health, and visual analog scale (VAS) for pain and satisfaction. Functional tests measured dorsiflexion (lunge test), calf endurance (heel rise test), and muscle strength (single-leg hop test), comparing operated vs unoperated legs. Results: ATRS and EQ-5D-5L Index improved from 2 to 5 years ( P = .0136, P = .0396), although significance was lost after Bonferroni correction. Functional test results remained stable. The operated limb achieved >90% of the nonoperated side across tests. Compared with controls, patients reported lower EQ-5D-5L scores and greater pain ( P < .05), but satisfaction remained high (VAS score 9/10). One retear occurred due to infection. Conclusion: Minimally invasive Achilles tendon reconstruction using hamstring autografts results in sustained functional and subjective improvements at a minimum of 5 years postoperatively. Despite modest residual deficits compared with uninjured controls, high satisfaction and strong limb symmetry support the long-term efficacy of this approach. This study demonstrates that the functional and subjective results of patients after Achilles tendon reconstruction with hamstring graft remain stable and satisfactory at a minimum of 5 years postoperatively. Level of Evidence: Level III, retrospective cohort study.

Background: Chronic Achilles tendon ruptures present a major surgical challenge due to tendon retraction, degeneration, and large defects. Autologous hamstring tendon grafts have emerged as a reliable reconstructive option, yet their biomechanical consequences remain poorly understood. This study investigated whether Achilles tendon reconstruction with semitendinosus and gracilis autografts alters the plantar flexor moment arm and whether such changes affect muscle strength. Methods: A cohort of 25 patients (mean age: 44.5 years) underwent minimally invasive endoscopic reconstruction using hamstring autografts. This secondary salvage procedure was performed in patients with neglected ruptures or failed primary treatment. Five patients were excluded from the original intervention group due to inadequate radiographic quality. Radiographic measurements of the Achilles tendon moment arm and isometric plantar flexor strength assessments were performed at 12 and 24 months postoperatively. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and correlation analyses. Results: Results showed a significant shortening of the Achilles tendon moment arm after reconstruction compared with the preoperative imaging length (mean reduction: 6.6 mm; p < 0.0001). Despite this, plantar flexor strength in the operated limb improved significantly over time at 12 and 24 months (+388.6 N at 24 months; p = 0.0067) and did not correlate with the degree of moment arm shortening (p > 0.3). By 24 months, the operated limb demonstrated comparable or greater strength than the contralateral side, with nearly half of the patients achieving substantial clinically meaningful improvements. Conclusions: In conclusion, Achilles tendon reconstruction with hamstring autografts leads to consistent moment arm shortening, yet this does not impair long-term restoration of plantar flexor strength. A progressive rehabilitation program extending up to two years appears essential to optimize recovery and compensate for biomechanical alterations.