ACFAS Clinical Consensus Statement: Acute Achilles Tendon Pathology

ChatGPT Achieves Only Fair Agreement with ACFAS Expert Panelist Clinical Consensus Statements

INTRODUCTION

As artificial intelligence (AI) becomes increasingly integrated into medicine and surgery, its applications are expanding rapidly-from aiding clinical documentation to providing patient information. However, its role in medical decision-making remains uncertain. This study evaluates an AI language model's alignment with clinical consensus statements in foot and ankle surgery.

METHODS

Clinical consensus statements from the American College of Foot and Ankle Surgeons (ACFAS; 2015-2022) were collected and rated by ChatGPT-o1 as being inappropriate, neither appropriate nor inappropriate, and appropriate. Ten repetitions of the statements were entered into ChatGPT-o1 in a random order, and the model was prompted to assign a corresponding rating. The AI-generated scores were compared to the expert panel's ratings, and intra-rater analysis was performed.

RESULTS

The analysis of 9 clinical consensus documents and 129 statements revealed an overall Cohen's kappa of 0.29 (95% CI: 0.12, 0.46), indicating fair alignment between expert panelists and ChatGPT. Overall, ankle arthritis and heel pain showed the highest concordance at 100%, while flatfoot exhibited the lowest agreement at 25%, reflecting variability between ChatGPT and expert panelists. Among the ChatGPT ratings, Cohen's kappa values ranged from 0.41 to 0.92, highlighting variability in internal reliability across topics.

CONCLUSION

ChatGPT achieved overall fair agreement and demonstrated variable consistency when repetitively rating ACFAS expert panel clinical practice guidelines representing a variety of topics. These data reflect the need for further study of the causes, impacts, and solutions for this disparity between intelligence and human intelligence.

LEVEL OF EVIDENCE

Level IV: Retrospective cohort study.

Percutaneous repair of the Achilles tendon with one knot offers equivalent results as the same procedure with two knots. A comparative prospective study

PURPOSE

The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots.

METHODS

All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group A), and 33 patients underwent percutaneous repair with one knot (Group B). All patients were treated by a single surgeon between 2019 and 2021 and were followed prospectively for 24 months.

RESULTS

Patients' characteristics at baseline were similar between the two groups, except for age [38.0(15.0) vs 32.0(15.0) years, P = 0.028]. The procedure took longer for the two knots technique [19.0(4.0) vs 13.0(3.0) min, P < 0.001]. The Achilles tendon total rupture score was not different between the two techniques (90.7 ± 3.26 vs 90.5 ± 2.18, P = 0.737), as was the elongation of the gastrosoleus-Achilles tendon complex measured by the Achilles tendon resting angle [-1.0(2.0) vs - 1.0(2.0), P < 0.380]. The calf circumference of the injured and non-injured leg did not differ between the groups. Plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups. The European Foot and Ankle Society and patient reported outcome measures score by Piedade et al. scores were not statistically significant different between the two groups. No patient experienced a re-rupture, a venous thrombo-embolism episode, or injury to the sural nerve.

CONCLUSION

The modified technique offered similar objective and subjective outcome measures, in addition to reduced operative time.

Achilles Tendon Rupture

There are many high-level studies comparing nonoperative treatment, open repair, and minimally invasive repair for Achilles tendon ruptures. This article summarizes the most up-to-date literature comparing these treatment options. The authors' preferred protocol for nonoperative treatment is discussed. Preferred techniques for open repair and chronic Achilles repair are discussed with reference to the literature.

Hip and knee kinematics, center of pressure position, and ground reaction force are associated with Achilles tendon force during jump landing

PURPOSE

Jump-landing exercises are often performed during the rehabilitation of Achilles tendon (AT) injuries. However, the factors that affect the AT force (ATF) during landing are unclear. This study aimed to determine the kinematics and ground reaction force (GRF) variables associated with the peak ATF during a drop vertical jump (DVJ).

METHODS

The landing phase of DVJ was evaluated in 101 healthy participants (46 males, age: 21.2 ± 1.4 years old) using a three-dimensional motion analysis system with two force plates. ATF was estimated from the ankle flexion angle and moment. Univariate and multivariate regression analyses were performed with the peak ATF as the dependent variable. The vertical GRF (VGRF), center of pressure (COP), forward trunk leaning, hip/knee/ankle joint angles at peak ATF, and sex were used as independent variables.

RESULTS

In the univariate regression analysis, larger VGRF (β = 0.813), more anterior COP position (β = 0.214), smaller knee flexion (β = -0.251) and adduction (β = -0.252), smaller hip flexion (β = -0.407), smaller forward trunk lean (β = -0.492), and male sex (β = -0.282) were significantly associated with a larger peak ATF. Multivariate analysis revealed that larger VGRF (β = 1.018), more anterior COP position (β = 0.320), a larger knee (β = 0.442), and smaller hip flexion (β = -0.205) were associated with the larger peak ATF.

CONCLUSIONS

The VGRF, COP position, and knee and hip flexion were independently associated with ATF. Modifying these factors may be useful in managing tendon loading during jump-landing exercises.

Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture

INTRODUCTION

Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR.

METHODS

This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain.

RESULTS

Kager's fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings.

CONCLUSION

Clinicians should be particularly aware of Kager's fat pad sign when examining lateral ankle radiographs for ankle injury.

LEVELS OF EVIDENCE

Level IV: Case control study.

Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment - a case series

PURPOSE

Evaluate the one-year postoperative outcomes in patients with Chronic Achilles tendon rupture.

METHODS

Patients surgically treated for Chronic Achilles tendon rupture (n = 22, 14 males and 8 females, mean age 61 ± 15) were evaluated by Achilles tendon Total Rupture Score, The Physical Activity Scale, The Foot and Ankle Outcome Score, Calf muscle endurance test, counter movement jump, Hopping, ultrasound measurement of tendon length, Achilles Tendon Resting Angle, dorsi flexion range of motion and calf muscle circumference. Muscle function and tendon length outcomes on the injured side were compared with the healthy side.

RESULTS

The patients scored a mean of 62 ± 26 on the Achilles tendon Total Rupture Score. Median scores on the injured compared with the healthy side were lower in heel-rise repetitions (20 vs 24 cm, p = 0.004), hel-rise height (8 vs 10 cm, p < 0.001), heel-rise total work (872 vs 1590 joule, p < 0.001) and hopping ratio (0.37 vs 0.48, p = 0.005). Median calf circumference was smaller (37 vs 38 cm, p = 0.001) and the mean tendon elongation greater on the injured side; Achilles tendon resting angle (55 vs 50°, p < 0.001) and ultrasound (22.4 vs 20.5 cm, p = 0.006).

CONCLUSIONS

At one year postoperatively, patients with chronic Achilles tendon rupture reported persistent limitations in subjective foot and ankle function. Heel-rise height and total work as well as hopping ratio were not recovered, and there was an elongation of the injured Achilles tendon compared with the healthy tendon.

LEVEL OF EVIDENCE

IV.