Search Results (132)

Background: This study aimed to investigate the effects of E. stephanianum-derived polyphenols on preventing the progression of collagen-induced arthritis (CIA) in mice and its associated metabolic alterations. Methods: The E. stephanianum plant was extracted, fractionated, and screened in vitro for anti-inflammatory, antibacterial, and antioxidant potential. Fraction 5 (identified as ellagic acid by nuclear magnetic resonance) exhibited the most potent activity and was selected for in vivo study. In the in vivo study, male DBA/1JGpt mice were randomized into five groups: control (CON), CIA (Model), low-dose extract (ES-L), high-dose extract (ES-H), and ellagic acid group. ES-L, ES-H, and ellagic acid were administered by daily oral gavage at 375, 750, and 250 mg/kg body weight, respectively, for 8 weeks. Arthritis severity was evaluated based on paw thickness, clinical score, ankle joint histopathology, and serum proinflammatory cytokine levels. To reveal the associated metabolic alterations, serum metabolites were characterized by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. Results: Both the whole extract and ellagic acid revealed pronounced anti-inflammatory, antibacterial, and antioxidant properties. In vivo treatment with ES-L, ES-H, or ellagic acid similarly and significantly ameliorated CIA severity, showing smaller paw swelling, reduced clinical arthritis scores, milder joint histopathological injury, and lower serum tumor necrosis factor-α and interleukin-6 concentrations than the model group. Untargeted metabolomics identified 20 differential metabolites, mainly including triacylglycerols (containing n-3 fatty acids), pro-inflammatory phospholipids, and spermic acid 1. Moreover, the treatments significantly altered amino acid and purine metabolism. Conclusions:E. stephanianum derived polyphenols, like ellagic acid, significantly prevented the progress of CIA in mice. These effects were associated with the alteration of metabolic profiles. Full article

Rheumatoid arthritis is a chronic inflammatory joint disease often accompanied by depressive symptoms, in which functional impairment does not always reflect the extent of structural joint damage. Sertraline, a selective serotonin reuptake inhibitor, may influence behavioural and neuroimmune pathways, but its effects on the relationship between joint pathology and functional performance remain unclear. This study evaluated whether sertraline affects functional performance independently of histopathological joint damage in collagen-induced arthritis. Male Wistar rats with collagen-induced arthritis were assigned to untreated or treatment groups receiving sertraline, methotrexate, combined methotrexate and sertraline, infliximab, or tocilizumab. Functional performance was assessed by spontaneous wheel-running activity, body weight, and joint swelling. At week 12, ankle joints underwent histopathological evaluation, and haematological parameters and serum cytokines were analysed. Sertraline did not reduce synovial inflammation, cartilage damage, or bone erosion, although sertraline-treated rats showed a smaller numerical decline in spontaneous wheel-running activity than rats with untreated collagen-induced arthritis. In contrast, methotrexate and biologic therapies improved both structural damage and functional outcomes. Functional performance did not consistently correlate with histopathological severity or circulating cytokine levels. Sertraline did not produce a significant improvement in histopathological outcomes compared with untreated collagen-induced arthritis, while the smaller numerical decline in exploratory wheel-running activity should be interpreted cautiously. Full article

Background/Objectives: Ankle arthrodesis is an effective treatment for advanced ankle arthritis. Although postoperative gait following open ankle arthrodesis has been investigated, gait characteristics after arthroscopic ankle arthrodesis remain less well characterized. Therefore, we aimed to investigate postoperative gait characteristics after arthroscopic ankle arthrodesis using a deep learning-based markerless motion capture system in this pilot observational study. Methods: Seven patients with degenerative ankle arthritis underwent arthroscopic ankle arthrodesis. Real-time gait analysis using a deep learning-based markerless motion capture system assessed gait speed, cadence, step length, stance and swing phases, and ankle range of motion preoperatively and at 1 year postoperatively. Postoperative findings were also compared with those of a minimally symptomatic comparison group. Clinical outcomes were evaluated with the Visual Analog Scale, Foot and Ankle Ability Measure (FAAM), Lower Extremity Functional Scale, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and the Karlsson Scale. Results: At the 1-year postoperative follow-up, no significant differences in any of the spatiotemporal gait parameters were found between patients and the comparison group. Preoperative ankle range of motion during the gait cycle showed significant deviations from that of the comparison group, which were largely attenuated at the 1-year follow-up, except for persistent plantarflexion restriction during terminal stance. Numerical improvements were observed in most clinical scores, whereas the FAAM-Sports subscale remained essentially unchanged. Conclusions: At 1 year postoperatively, spatiotemporal gait parameters did not differ significantly from those of the comparison group, although terminal stance plantarflexion restriction persisted. Markerless motion capture provided objective gait data in a routine clinical setting, but its accuracy requires validation against standard marker-based systems. Full article

Background/Objectives: Total ankle arthroplasty (TAA) is increasingly used to treat end-stage ankle arthritis, but comprehensive cross-registry data on revision patterns remain limited. This study describes indications, causes, and patient risk factors for revisions using three national registries. Methods: Aggregate data were extracted from the UK National Joint Registry (NJR; 22nd Annual Report 2025; n = 11,321), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR; 2025 Ankle Supplementary Report; n = 5379), and the Swedish Ankle Registry (SwedAnkle; Annual Report 2024; n = 1852; survival estimates from a published sub-cohort, n = 1226). Metrics were compared descriptively without inferential pooling. Results: Across registries, 18,552 primary TAAs were identified. Ten-year cumulative per cent revision (CPR) was 9.54% (95% confidence interval [CI], 8.75–10.39) in the NJR, 13.5% (95% CI, 12.1–15.1) in the AOANJRR osteoarthritis sub-cohort, and approximately 26% (author-derived from Kaplan–Meier curves; see Methods) in SwedAnkle (1993 onwards implants). Aseptic loosening was the predominant cause of revision in all three registries; the rank of subsequent causes differed between registries (infection was second in the NJR and AOANJRR; in SwedAnkle, infection ranked below insert wear/breakage at 11.5%). AOANJRR Cox analysis identified younger age (hazard ratios (HRs), 2.00 for <55 vs. ≥75 years; 95% CI, 1.30–3.07; p = 0.001), earlier surgical era (HR, 1.91 for pre-2015 vs. 2015–2024; 95% CI, 1.53–2.38; p < 0.001), and obesity (HR, 1.52 for body mass index (BMI) ≥ 30; 95% CI, 1.06–2.19; p = 0.023) as significant independent predictors in AOANJRR Cox proportional hazards models (osteoarthritis sub-cohort for age, sex, BMI and ASA; all-diagnoses primary cohort for surgical era). Sex and American Society of Anesthesiologists (ASA) scores were not significant. Conclusions: Aseptic loosening was the predominant cause of revision in all three registries. The rank of subsequent causes differed: in the NJR and AOANJRR, infection was the second most frequent cause; in SwedAnkle, infection ranked below insert wear/breakage. Younger age, obesity, and earlier surgical era were independent predictors of revision in AOANJRR Cox proportional hazards models. The post-2015 era was associated with approximately 48% lower revision hazard; this association cannot be interpreted causally, as the independent contributions of implant design, surgical technique, patient selection, and other secular changes cannot be isolated from registry data. These findings may inform preoperative counselling, implant selection, and registry harmonisation efforts. Full article

Background/Objectives: Information on the effects of total ankle arthroplasty (TAA) on postural control ability and their clinical significance remains insufficient. This study aimed to investigate changes in postural control ability following TAA for end-stage ankle arthritis and to identify their correlation with clinical outcome measures. Methods: The study included 32 patients under the age of 70 who underwent TAA for end-stage osteoarthritis and were followed for at least 3 years. Clinical outcomes, including abilities in daily living and sports activities, were evaluated using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Postural control ability was assessed using the static and dynamic stability test modes of Biodex posturography. Spearman’s correlation coefficient (r) was analyzed to determine the linear association between postural control ability and clinical outcome measures. Results: The FAOS and FAAM scores significantly improved from a preoperative mean of 32.5 and 34.1 to 82.3 and 83.6 at the final follow-up (p < 0.001), respectively. Posturographic evaluation showed a mean overall stability index of 1.52 for static postural control and 2.56 for dynamic postural control at the final follow-up. FAOS demonstrated no significant correlation with static postural control (r = −0.11, p = 0.425), but showed a significant correlation with dynamic postural control (r = −0.35, p = 0.021). Similarly, FAAM scores did not correlate significantly with static postural control (r = −0.26, p = 0.103), but demonstrated a significant correlation with dynamic postural control (r = −0.57, p < 0.001). Conclusions: TAA failed to bring a statistically significant improvement in postural control ability. Dynamic postural control ability after TAA was found to have a significant correlation with patient-reported clinical outcomes. To enhance postoperative clinical outcomes, including abilities for daily living and sports activities, biomechanical assessment and targeted rehabilitation strategies to improve postural control ability may be helpful. Full article

Background/Objectives: Patients with acute anterior uveitis (AAU) have a high prevalence of occult spondyloarthropathy (SpA). Only one previous study investigated ultrasonographic (US) changes at peripheral entheses and joints in patients with acute anterior uveitis (AAU) and no study has used these data in recognizing unknown SpA as defined by ASAS criteria. No previous study compared non-granulomatous (NGAU) with granulomatous uveitis (GAU) for these US features. The objective of this study was to investigate the prevalence of US enthesis and joint abnormalities in a consecutive series of GAU and NGAU patients and to use these data in recognizing unknown SpA as defined by ASAS criteria. Methods: A total of 152 consecutive patients diagnosed with AAU [103 NGAU (42 B27−, 61 B27+) and 49 GAU] from the Immunology Eye Unit (AUSL-IRCCS Reggio Emilia, Italy) were enrolled in this study. Six peripheral entheses as well as knee and ankle joints were bilaterally evaluated by US according to standard methods. The presence of any elementary lesion, structural damage and active enthesitis, according to OMERACT definitions, was recorded. ASAS classification criteria of SpA were integrated with the US data of active enthesitis and joint synovitis in defining the presence of enthesitis and arthritis. Results: NGAU patients had a higher prevalence of entheseal erosions (11.9% vs. 9%, P0 0.009), of enthesis exhibiting a PD signal (29.7% vs. 12.2%, p = 0.025) and of active enthesitis (23% vs. 8.2%, p = 0.026) compared with GAU group. Unknown SpA as defined by ASAS criteria was recognized in 29 patients by clinical and MR/Rx examination of sacroiliac joints and in 13 additional patients with the use of US data. Conclusions: Acute entheseal lesions and erosions are associated with NGAU, without apparent influence of HLA-B27 positivity. US examination helps to recognize previously unknown SpA and to define the disease phenotype of patients, moving toward more personalized treatment. Full article

Background: Osteochondral lesions of the lateral talar shoulder (OLT) represent a significant therapeutic challenge, particularly when associated with chronic lateral ankle instability (CAI). While bone marrow stimulation is well established for talar lesions, clinical evidence on the minced cartilage technique (AutoCart™, Arthrex, Naples, FL, USA) in this specific localization remains limited. This study aimed to evaluate the short-term clinical and functional outcomes following combined treatment of lateral OLT and CAI using autologous minced cartilage and open ligament repair. Methods: Nine patients (mean age: 39.8 years) with symptomatic lateral OLT and concomitant CAI were treated using the minced cartilage technique in conjunction with lateral ligament reconstruction. The mean defect size was 64.8 ± 30.2 mm². Clinical and functional outcomes were assessed at a mean follow-up of 15.8 months using the Foot Function Index (FFI), Visual Analog Scale (VAS) for pain, return-to-sport status, and a motor-cognitive test (Skillcourt system). Postoperative complications and patient satisfaction were recorded. Results: No postoperative complications occurred. All patients reported satisfaction with surgical outcomes. The mean postoperative FFI was 14.92 ± 12.74, indicating minimal functional limitations in daily life. Skillcourt testing revealed no significant side-to-side differences in most tests, except for the Single Leg Stability Test, which showed a significant deficit on the operated side (p = 0.027; Cohen’s d = 0.9). Reduced dorsiflexion limited test performance of four patients. The average postoperative VAS during functional testing was 1.42 ± 1.62. Conclusions: Combined treatment of lateral OLT and CAI using the minced cartilage technique and open ligament stabilization yields favorable short-term clinical and functional outcomes. Despite minor limitations in dorsiflexion, patients achieved high satisfaction rates and functional recovery. These preliminary findings support the technical feasibility and short-term clinical applicability of combining biological cartilage repair with mechanical stabilization for lateral talar lesions < 100 mm². However, larger prospective studies with longer follow-ups are warranted to validate these findings. Full article

The available literature provides limited and inadequate data regarding the association between intraoperative knee kinematics, long-term clinical outcomes and survivorship after total knee arthroplasty (TKA). This study aimed to examine the potential relationship between specific intraoperative kinematics laxity assessment, acquired with a computer navigation system, and the long-term clinical outcomes and survivorship in patients undergoing TKA. This study consists of a retrospective cohort analysis of consecutive TKA procedures, in which a surgical navigation system was utilized to intra-operatively assess bone resections, implant positioning and gap balancing. The intraoperative kinematic parameters included varus-valgus laxity at 0° (VV 0) and 30° of flexion (VV 30), anterior–posterior displacement at 90° of flexion (AP 90), and passive range of motion (ROM). Different prosthesis designs were used, with a predominance of the posterior stabilized (PS)-type implant. The Knee Injury and Osteo-arthritis Outcome Score (KOOS) was used to investigate patients’ clinical and functional status. Survival was analyzed with the Kaplan–Meier method. Between-group comparisons were performed using the Mann–Whitney U test. A univariate logistic regression analysis was conducted to identify factors associated with clinical failure. Of 165 eligible patients, 120 were included in the final analysis, with a mean follow-up of 7.7 ± 2.8 years. Revision surgery was required in seven cases, representing surgical failure and an overall survival rate of 94.2%, with survival probabilities of 98.8%, 97.4%, and 93.6% at 6, 8, and 10 years, respectively. Clinical failure (KOOS < 70 in three domains) occurred in 23 patients. No intra-operative surgical parameters, including Hip-Knee-Ankle angle, Preoperative KL grade, prostheses design, VV 0, VV 30, AP 90 and ROM, or demographic variables, were found to be statistically correlated with clinical failure at follow-up. Although, in this navigated TKA cohort, survivorship was acceptable and consistent with previously reported benchmarks, it was not possible to reliably predict survival probability based solely on the intra-operative laxity parameters measured. Nevertheless, the use of surgical navigation can help surgeons accurately assess bone resections and the balance of prosthetic components. Full article

Background: Children with juvenile idiopathic arthritis (JIA) exhibit gait abnormalities, postural instability, and compensatory movement strategies due to joint pain, inflammation, and reduced neuromuscular control. These alterations negatively affect functional mobility and movement efficiency. Although gait retraining is commonly recommended in rehabilitation, objective evidence on its short-term biomechanical effects remains limited. This study aimed to evaluate the immediate impact of a single-session standardized movement training intervention on gait biomechanics in children with JIA. Methods: Seventeen children with JIA underwent pre–post gait assessments using the Xsens MVN Awinda wearable motion capture system. The intervention focused on step symmetry, stride length, heel–toe progression, and upright trunk posture, delivered by an experienced physiotherapist following a standardized protocol. Scalar kinematic outcomes were analyzed using paired statistical tests, and time-normalized kinematic waveforms were compared with healthy reference data from 25 age-matched participants derived from the COMPWALK-ACL dataset. Results: Significant improvements were observed in multiple gait parameters following the intervention. Trunk lateral lean decreased significantly (p = 0.0002; d = −1.35), indicating enhanced postural stability. Significant changes were also found in ankle dorsiflexion–plantarflexion (p = 0.0081; d = 0.83) and knee flexion–extension (p = 0.0252; d = 0.68). Waveform analyses showed increased similarity to healthy patterns, particularly in trunk and knee kinematics. Spatiotemporal parameters reflected a slower, more controlled gait pattern, with increased stride time and stance duration. Conclusions: A single session of standardized movement training can produce immediate improvements in gait biomechanics in children with JIA, especially in trunk control and lower-limb kinematics. Wearable motion analysis provides a sensitive tool for detecting these short-term adaptations and supports the inclusion of structured movement training in pediatric JIA rehabilitation. Full article

This study aims to evaluate the therapeutic efficacy of emodin (EMO) in rheumatoid arthritis (RA) and to verify whether its underlying mechanism involves the blockade of pathological angiogenesis via the inhibition of the nuclear factor-kappa B (NF-κB)/hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling axis. Bovine type II collagen-induced arthritis (CIA) mouse models and lipopolysaccharide (LPS)-stimulated EA.hy926 endothelial cells were utilized in this study. The effects of EMO on joint pathological alterations, the expression of NF-κB/HIF-1α/VEGF axis proteins, inflammatory cytokines (tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β)), and angiogenic capacity were assessed using histopathological analysis, Western blotting, immunohistochemistry (IHC), immunofluorescence, and tube formation assays. Furthermore, small interfering RNA (siRNA) interference targeting key molecules was employed to validate the molecular mechanisms underlying the therapeutic effects of EMO. In the CIA model group, the ankle joints of mice exhibited pronounced inflammatory infiltration, synovial hyperplasia, and bone destruction. Compared with the model group, both the EMO and methotrexate (MTX) treatment groups demonstrated attenuated synovial hyperplasia and cartilage destruction, along with significantly downregulated expression levels of key NF-κB pathway proteins, HIF-1α, and VEGF in joint tissues (p < 0.001). In vitro experiments revealed that EMO treatment significantly reduced the LPS-induced secretion of pro-inflammatory cytokines (TNF-α, IL-6, and IL-1β) (p < 0.001), and decreased both the number and total length of tubular structures formed by endothelial cells compared to the control (p < 0.001). Notably, siRNA-mediated knockdown of p65 resulted in decreased intracellular protein levels of HIF-1α and VEGF, accompanied by a significant reduction in tube formation (p < 0.001). This study demonstrates that EMO alleviates pathological damage in RA by inhibiting the activation of the NF-κB signaling pathway, which subsequently downregulates pathological angiogenesis and inflammatory responses mediated by the HIF-1α/VEGF axis. These findings provide a robust experimental basis for the potential application of EMO as a therapeutic agent for RA. Full article

Background and Clinical Significance: Talar body fractures are very rare injuries, and their occurrence alongside ipsilateral fractures is even more uncommon. We present a case of a 40-year-old male who sustained a talar body fracture combined with an ipsilateral bimalleolar fracture after falling from a height, a combination previously described in only two cases. Case Presentation: Open reduction and internal fixation (ORIF) were performed using dual approaches for both the talus and malleolar fractures. Postoperatively, the rehabilitation protocol included a non-weight-bearing short leg cast, followed by partial weight-bearing with a controlled ankle movement (CAM) boot. At one-year follow-up, the patient achieved an American Orthopedic Foot and Ankle Society (AOFAS) score of 90 and reported minimal pain. Radiographs demonstrated minimal osteoarthritic changes and no signs of osteonecrosis. Nevertheless, early signs of osteonecrosis (ARCO grade I) were detected on MRI 15 months postoperatively. Conclusions: This case highlights the rarity of such injuries, outlines our institution’s treatment approach, and emphasizes the importance of long-term follow-up to monitor for complications such as post-traumatic arthritis and osteonecrosis. Full article

Residual valgus instability following ankle fracture fixation presents a reconstructive challenge, especially when medial soft tissue compromise precludes early deltoid ligament repair. Restoring medial stability, together with fibular length and syndesmotic alignment, is crucial for re-establishing joint congruity and preventing progressive deformity or degenerative complications. In this single-patient case report, we describe a novel technique combining the use of an allograft deltoid ligament reconstruction with a Z-lengthening distal fibular osteotomy in a young adult male who developed residual valgus instability after the lateral-only fixation of a Weber C ankle fracture–dislocation. The Z-lengthening osteotomy enabled the controlled, fluoroscopy-guided restoration of fibular length and the correction of syndesmotic malreduction. Concurrently, medial stabilization was achieved with a suspensory-and-aperture fixation allograft construct, providing a tensionable anatomic reconstruction of the deltoid complex. This integrated approach restored the alignment of the medial clear space and syndesmosis, resulting in a pain-free, stable ankle mortise. At the three-year follow-up, the patient maintained a stable reduction with no radiographic signs of post-traumatic arthritis. The technique offers a reproducible, joint-preserving solution that merges mechanical correction with biological reconstruction to restore circumferential ankle stability and facilitate functional rehabilitation after complex ankle fracture fixation. Full article

Medial opening-wedge supramalleolar osteotomy (MOWSMO) is a joint-preserving surgical option for varus ankle osteoarthritis (OA); however, its ability to correct large varus talar tilt (TT), particularly in advanced diseases like Takakura stage IIIB, remains limited. Varus TT represents a complex three-dimensional deformity characterized by coronal malalignment and internal rotation, which cannot be reliably corrected by isolated supramalleolar realignment. Building on our previous work, we propose a new treatment algorithm for large varus TT based on preoperative tibial plafond inclination (TPI) and arthritis type, categorized as translational and rotational. While MOWSMO primarily addresses TPI, effective correction of talar inclination requires a balanced, multilevel approach. This includes using an oblique sliding fibular osteotomy to facilitate rotational realignment with fibular shortening and, critically, prioritizing inframalleolar correction (IMC). IMC is implemented through an “all-in-one” strategy involving lateral ligament repair, deltoid ligament release, calcaneal osteotomy, and posterior tibial tendon lengthening. Furthermore, we discuss critical intraoperative considerations, such as avoiding excessive TPI valgization to prevent a “paradoxical increase” in TT. Collectively, this framework provides clinically relevant insights and a reproducible algorithm for achieving satisfactory outcomes in the joint-preserving management of severe varus ankle OA. Full article

This research aims to develop a chitosan-coated, TH-loaded nanobilosomal gel (CH-TH-BG) to magnify the transdermal delivery and anti-inflammatory efficacy of thymol (TH) for the management of rheumatoid arthritis (RA). Initially, chitosan-coated, TH-loaded bilosomes (CH-TH-BLs) were prepared and optimized by Box–Behnken design. The optimized CH-TH-BLs exhibited enhanced entrapment efficiency (83.52%) and a positive zeta potential (+36.3 mV). Further, the optimized lyophilized CH-TH-BLs were incorporated into the carbopol gel (CH-TH-BG) and characterized thoroughly. The CH-TH-BG exhibited superior pharmaceutical properties, including high drug content (98.65 ± 1.43%), optimal viscosity (10,400 ± 12.6 cps), excellent spreadability (5.33 ± 0.15 cm), extrudability, and a slightly acidic pH (5.40 ± 0.10), which resembles the pH of human skin. In vitro drug release revealed that the developed gel exhibited a biphasic release pattern, with a rapid release followed by sustained release. Notably, ex vivo results revealed a ~2.0-fold increase in permeation flux and a ~2.8-fold increase in skin retention compared to the TH solution. In vivo results confirmed a significant reduction in paw edema and pro-inflammatory biomarkers (TNF-α and IL-6), alongside recovery of body weight and ankle joints. In conclusion, the CH-TH-BG is a transformative transdermal platform for effective management of RA. Full article

Background/Objectives: Bilateral Achilles tendon ruptures are exceptionally rare, accounting for <1% of Achilles injuries; chronic presentations are frequently linked to diagnostic delay in the acute phase. The aim of this paper is to describe a modified, single-stage bilateral reconstruction of neglected Achilles tendon ruptures using Flexor Digitorum Longus (FDL) transfer and turndown flaps. This study evaluates 12-month functional and radiological outcomes while comparing this surgical strategy with current literature. Methods: A 58-year-old man with rheumatoid arthritis on long-term corticosteroids presented 4 months after asynchronous bilateral Achilles ruptures with progressive weakness and gait limitation. Clinical examination and MRI confirmed chronic discontinuity with retracted stumps and interstump gaps of ~6.5–7.0 cm. Intervention: After pre-operative tapering of corticosteroids, a single-stage bilateral reconstruction was performed. Surgical intervention involved simultaneous bilateral reconstruction using flexor digitorum longus (FDL) transfer for one tendon and a combination of FDL and flexor hallucis longus (FHL) transfers for the other, with bilateral turndown flap augmentation. Decisions regarding tendon transfers were based on intraoperative findings, with the FDL selected for its larger caliber when the FHL was deemed insufficient. Results: Recovery was uneventful. At 6 months, the patient resumed full-time work and could perform repeated tiptoe rises. The AOFAS ankle-hindfoot score improved from 46 pre-operatively to 85. At 12 months, MRI demonstrated bilateral tendon continuity without re-rupture, with hypertrophy at the reconstructed stumps. Conclusions: In chronic, large-gap bilateral Achilles ruptures with systemic risk factors, single-stage reconstruction using FDL (with or without FHL) plus turndown augmentation is feasible and yields favorable functional recovery. Careful tensioning, secure calcaneal fixation, steroid optimization, and structured rehabilitation appear pivotal to outcomes. This case supports the applicability of this strategy in complex bilateral presentations. Full article