COMPARISON OF SINGLE-ROW VERSUS DOUBLE-ROW REPAIR IN THE SURGICAL MANAGEMENT OF ACHILLES INSERTIONAL TENDINOPATHY: A SYSTEMATIC REVIEW
Bibliographic record
Abstract
Approximately 6% of the general population will report Achilles tendon pain during their lifetime, and one third of these patients will have insertional Achilles tendinopathy (IAT). For patients who fail conservative treatment, surgical debridement and reattachment is performed. Repair of the Achilles tendon can occur through various techniques, including a single row (SR) repair or a double row (DR) repair. The purpose of this systematic review was to determine if there are significant differences or advantages of double row repairs over single row repairs in terms of the biomechanical and clinical outcomes. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of IAT. This included both biomechanical and clinical studies. For clinical studies where patients were not diagnosed with IAT, underwent surgery for repair of Achilles tendon ruptures, or included additional procedures such as a concomitant flexor hallicus longus transfer for repair of IAT, they were excluded. Eligible studies were independently screened by two reviewers. A risk of bias assessment was conducted using the Cochrane Robins-I and RoB 2 tools. A total of 23 studies were included, four of which were biomechanical studies and 19 were clinical studies. Several studies that performed a biomechanical comparison found that there was a significant advantage to using double row fixation with respect to load at yield (198.7 N vs 354.7 N, p = 0.01), peak load (212 N vs. 433.9 N, p = 0.042), and ultimate failure load (344.5 N vs 462.5 N, p = 0.064). There was no significant difference between double row and single row repair with respect to load at failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double row repairs versus single row repairs. Although the biomechanical studies favour double row repair for IAT, the data available in the current literature on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double row repairs. Larger, prospective randomized trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double row repair also translate into improved patient-reported outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".