Foot & Ankle Orthopaedics · Published 2026-07-01 · DOI 10.1177/24730114261462481
Steven M. Hadley, John J. Peabody, Rachel Bergman, Eric H. Durudogan, Sarah J. Westvold, Frederic Washburn, Muhammad Y. Mutawakkil, Milap Patel, Anish R. Kadakia
Background: Prior literature suggests that patients suffering from fear of reinjury (FORI) following Achilles rupture may fail to return to sport and report worse Achilles Tendon Total Rupture Scores (ATRS); however, this prior study included patients who underwent both surgical and non-surgical management. This study therefore aims to determine whether self-reported fear (srFORI) is associated with worse outcomes as measured by validated Patient-Reported Outcomes Measurement Information System (PROMIS) measures of physical function (PF) and pain interference (PI) and ATRS following operative Achilles repair specifically. Methods: This investigation was a retrospective review of all patients who underwent Achilles repair at a single institution (2018-2023). Tendinopathies, open injuries, concomitant fractures, tendon transfers, and gastrocnemius recessions were excluded. A total of 119 patients completed questionnaires containing PROMIS and ATRS, and additional surveys querying srFORI measured at the time of survey participation. Primary outcome was PROMIS. Secondary outcome was ATRS. Results: Mean follow-up duration was 30.3 ± 8.3 months. No significant differences existed in baseline characteristics ( P > .05). Twenty-nine of 119 patients (24.4%) self-reported FORI. SrFORI was associated with significantly worse PF relative to those without srFORI (53.0 ± 6.1 vs 59.0 ± 8.1, mean difference (MD) −6.08, 97.5% CI −9.79, −2.36, P < .001). SrFORI was similarly associated with significantly worse ATRS (72.6 ± 17.8 vs 88.7 ± 12.3, MD −16.18, 97.5% CI: −22.89, −9.47, P < .001). There were no significant differences in PI (44.9 ± 7.0 vs 43.9 ± 6.1, MD 1.03, 97.5% CI: −2.04, 4.11, P = .48). Adjusted regression revealed that srFORI was associated with significantly worse PF (MD 6.2 points lower, P < .001) and ATRS (MD 16.5 points lower, P < .001). Both differences in PF and ATRS reached MCID. With the numbers available, no significant difference in overall complications could be detected between groups (7.8%, 7/90, vs 10.3%, 3/29, P = .70). Conclusion: Nearly 25% of patients self-reported FORI following minimally invasive Achilles tendon repair, which may be associated with clinically and statistically significant deficits in functional outcomes as measured by PROMIS and ATRS following repair. Level of Evidence: Level III, retrospective cohort study.
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Hadley, S., Peabody, J., Bergman, R., et al. (2026). Fear of Reinjury Is Associated With Worse Physical Function Measured by PROMIS Following Minimally Invasive Achilles Rupture Repair. Foot & Ankle Orthopaedics. https://doi.org/10.1177/24730114261462481