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What's New — Ankle — November 2025

9 new articles published this month.

Themes: Achilles Tendinopathy and Healing Mechanisms · Ankle Instability: Diagnosis and Muscle Deficits · Rare Trauma and Ankle Arthroplasty Complications

Digest generated 2026-04-16 00:32:12+00:00.

Highlights

Achilles Tendinopathy and Healing Mechanisms

Recent literature explores biological and structural aspects of Achilles pathology. Research indicates that rapamycin-mediated inhibition of the mTOR pathway can promote tendon healing in collagenase-induced tendinopathy models [1]. On the structural side, a rare case of giant calcific insertional Achilles tendinopathy with Haglund's deformity following childhood lengthening highlights complex long-term sequelae [3]. Furthermore, anatomical studies have detailed the morphological characteristics of the flexor hallucis longus-associated portion of Kager's fat pad, a structure intimately linked to the Achilles tendon's environment [8]. These studies collectively advance understanding of both cellular healing pathways and anatomical variations in the posterior ankle.

Ankle Instability: Diagnosis and Muscle Deficits

Several studies focus on the prevalence and physiological underpinnings of ankle instability. A significant proportion of adolescent male soccer players exhibit increased lateral ankle laxity accompanied by functional impairments, suggesting a need for targeted screening in this demographic [6]. In clinical populations with functional ankle instability, distinct deficits in gastrocnemius and soleus muscle strength (both eccentric and concentric) have been identified, correlating with balance and functional performance issues [7]. Additionally, outcomes of arthroscopic-assisted mini-open anatomic reconstruction using autologous tendon demonstrate effective functional recovery for ankle ligament injuries, offering a surgical solution for chronic instability [2].

Rare Trauma and Ankle Arthroplasty Complications

This theme covers unique traumatic presentations and complications in joint replacement. A rare case report documents an isolated traumatic fracture of Kager's fat pad without concomitant Achilles tendon injury, expanding the differential diagnosis for posterior ankle pain [5]. In the realm of joint preservation and replacement, a scoping review addresses the challenging issue of osteolysis in total ankle arthroplasty, summarizing current treatment strategies for this complication [4]. These articles highlight the spectrum of rare injuries and the ongoing management challenges in reconstructive ankle surgery.

Articles by Theme

Achilles Tendinopathy and Healing Mechanisms (3)

1. Zhang E, Wang X, Zhou Z, et al. Rapamycin-mediated inhibition of the mTOR pathway promotes tendon healing in a collagenase-induced achilles tendinopathy. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06524-2

Researchers investigated the therapeutic potential of rapamycin in a collagenase-induced rat model of Achilles tendinopathy by inhibiting the mTOR pathway. The study found that rapamycin treatment significantly promoted tendon healing and improved tissue regeneration compared to controls. These findings suggest that mTOR inhibition could serve as a promising pharmacological strategy for enhancing tendon repair in clinical settings.

3. Li Z, Wei W, Yao Z, et al. Giant calcific insertional Achilles tendinopathy with Haglund’s deformity following childhood tendon lengthening: a rare case report. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09325-0

A rare case of giant calcific insertional Achilles tendinopathy accompanied by Haglund's deformity is reported in a patient who underwent childhood tendon lengthening. The case highlights the unique long-term complications that can arise from pediatric tendon procedures, necessitating specific surgical considerations for calcific deposits and bony deformities. Clinicians should maintain a high index of suspicion for such rare presentations when evaluating patients with a history of childhood tendon surgery.

8. Sakamoto K, Edama M, Ishigaki T, et al. Morphological characteristics of the flexor hallucis longus-associated part of Kager’s fat pad. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09276-6

This study characterized the morphological features of the flexor hallucis longus-associated portion of Kager's fat pad using anatomical dissection and imaging. The research provided detailed insights into the structural relationship between the fat pad and the flexor hallucis longus tendon, which is often implicated in posterior ankle pathology. Understanding these anatomical variations is essential for surgeons to avoid iatrogenic injury and accurately diagnose fat pad-related disorders.

Ankle Instability: Diagnosis and Muscle Deficits (3)

2. Yang S, Ma C, Wang L, et al. Outcomes of arthroscopic-assisted mini-open anatomic reconstruction using autologous tendon for ankle ligament injuries and its effect on functional recovery. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09323-2

This study evaluated the clinical outcomes and functional recovery of patients undergoing arthroscopic-assisted mini-open anatomic reconstruction using autologous tendons for ankle ligament injuries. Results indicated that the procedure effectively restored ankle stability and facilitated significant improvements in functional scores post-operatively. The technique is clinically supported as a viable option for restoring function in patients with chronic ankle ligament instability.

6. Yokoe T, Kawaguchi T, Kubo A, et al. Approximately two‐thirds of adolescent male soccer players had increased lateral ankle laxity with functional ankle impairments. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70184

This study assessed the prevalence of increased lateral ankle laxity and associated functional impairments in adolescent male soccer players using ultrasonography and functional tests. Approximately two-thirds of the participants exhibited increased lateral ankle laxity, which was significantly correlated with functional ankle impairments and reduced muscle strength. These results suggest that screening for laxity and neuromuscular deficits should be integrated into preventive programs for young athletes to mitigate chronic instability risks.

7. Abdelkader NA, Khafagaa MM, Aziz MZ. The gastrocnemius and soleus muscles deficits in functional ankle instability: an observational study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09286-4

An observational study compared gastrocnemius and soleus muscle strength deficits between affected and non-affected limbs in patients with functional ankle instability. The findings revealed significant eccentric and concentric strength deficits in the affected limb, which correlated with poor balance and functional performance scores. These results indicate that rehabilitation protocols for functional ankle instability should prioritize targeted strengthening of the calf muscles to improve stability and function.

Rare Trauma and Ankle Arthroplasty Complications (2)

4. Seidel A, Li M, Lalonde K, et al. Scoping review for treatment of osteolysis in total ankle arthroplasty. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09278-4

This scoping review systematically analyzed current literature regarding the management of osteolysis following total ankle arthroplasty. The review identified various treatment modalities ranging from observation to revision surgery, noting a lack of standardized protocols for this complication. The findings underscore the need for further high-quality studies to establish evidence-based guidelines for preventing and treating osteolysis in ankle arthroplasty.

5. Di Castro Horn V, Hurley M, Andrews E, et al. Traumatic fracture of Kager’s fat pad: a case report. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09336-x

A case report describes an isolated traumatic fracture of Kager's fat pad in a 31-year-old female athlete, diagnosed via musculoskeletal ultrasound without concomitant Achilles tendon injury. The case demonstrates that pathology of the Kager's fat pad should be considered in the differential diagnosis of posterior ankle pain following trauma. Early recognition of this rare injury is crucial to prevent misdiagnosis and ensure appropriate management.

9. Baek CH, Kim BT, Kim JG, et al. Comparative outcomes of middle trapezius tendon transfer using Achilles tendon allograft vs. fascia lata autograft for isolated supraspinatus tendon tears. Journal of Shoulder and Elbow Surgery 2025. doi:10.1016/j.jse.2025.02.021

This study compared clinical outcomes of middle trapezius tendon transfers for isolated supraspinatus tears using either Achilles tendon allograft or fascia lata autograft. The key finding indicated no significant difference in functional scores or complication rates between the two graft types. Clinically, this suggests that Achilles allograft is a viable alternative to autograft, potentially reducing donor site morbidity and operative time.

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