Achilles tendon ruptures are increasing in incidence, with the greatest incidence in the over 60s age group. The rehabilitation time following this injury is prolonged and patients have calf weakness of up to 30%.
There is debate over the optimal method of management between nonoperative and operative repair, followed by rehabilitation. Aims of treatment are to restore activities of daily living and sports activity with minimal complications. Operative treatment reduces tendon elongation, minimizes calf weakness, and may depending upon the age of the patient reduce the re-rupture rate.
Open repair is the traditional operative technique although there is increasing evidence of the effectiveness of percutaneous and minimally invasive surgery. The avoidance of early weight-bearing does not prevent tendon lengthening.
Nonoperative treatment consisting of 2 weeks in cast followed by the use of an adjustable external equinus corrected brace and rehabilitation shows low re-rupture rates and allows patients to return to daily activities without a problem.
Management of Achilles tendon rupture must be tailored to individual patient requirements for the resumption of day-to-day activities, return the return to sport with optimal ankle plantar flexion strength and the risk of re-rupture.
Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 1999;9(3):157–60.CrossRefGoogle Scholar
Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957;179(1069):56–8.PubMedGoogle Scholar
Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998;26(2):266–70.CrossRefGoogle Scholar
Reiman M, Burgi C, Strube E, Prue K, Ray K, Elliott A, et al. The utility of clinical measures for the diagnosis of achilles tendon injuries: a systematic review with meta-analysis. J Athl Train. 2014;49(6):820–9.CrossRefGoogle Scholar
Dams OC, Reininga IHF, Gielen JL, van den Akker-Scheek I, Zwerver J. Imaging modalities in the diagnosis and monitoring of Achilles tendon ruptures: a systematic review. Injury. 2017;48(11):2383–99.CrossRefGoogle Scholar
Thompson TC. A test for rupture of the tendo achillis. Acta Orthop Scand. 1962;32:461–5.CrossRefGoogle Scholar
Thermann H, Zwipp H, Tscherne H. Functional treatment concept of acute rupture of the Achilles tendon. 2 years results of a prospective randomized study. Unfallchirurg. 1995;98(1):21–32.PubMedGoogle Scholar
Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010;92(17):2767–75.CrossRefGoogle Scholar
Ingvar J, Tagil M, Fau - Eneroth M, Eneroth M. Nonoperative treatment of Achilles tendon rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop. 2005;76(4):597–601. (1745-3674 (Print)).CrossRefGoogle Scholar
Nilsson-Helander K, Silbernagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38(11):2186–93.CrossRefGoogle Scholar
Hutchison AM, Topliss C, Beard D, Evans RM, Williams P. The treatment of a rupture of the Achilles tendon using a dedicated management programme. Bone Joint J. 2015;97-B(4):510–5.CrossRefGoogle Scholar
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94(23):2136–43.CrossRefGoogle Scholar
Ecker TM, Bremer AK, Krause FG, Muller T, Weber M. Prospective use of a standardized nonoperative early weightbearing protocol for Achilles tendon rupture: 17 years of experience. Am J Sports Med. 2016;44(4):1004–10. (1552-3365 (Electronic)).CrossRefGoogle Scholar
Lawrence JE, Nasr P, Fountain DM, Berman L, Robinson AH. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J. 2017;99-B(1):87–93.CrossRefGoogle Scholar
Karlsson J, Olsson N, Carmont MR, Nilsson-Helander K, Thermann H, Becher C, Carmont MR, Jón K, Maffulli N, Calder J, et al. The Achilles tendon an atlas of surgical procedures. Berlin, Heidelberg: Springer; 2017. p. 3–6.Google Scholar
Horstmann T, Lukas C, Merk J, Brauner T, Mundermann A. Deficits 10-years after Achilles tendon repair. Int J Sports Med. 2012;33(6):474–9.CrossRefGoogle Scholar
Silbernagel KG, Steele R, Manal K. Deficits in heel-rise height and achilles tendon elongation occur in patients recovering from an Achilles tendon rupture. Am J Sports Med. 2012;40(7):1564–71.CrossRefGoogle Scholar
Yammine K, Assi C. Efficacy of repair techniques of the Achilles tendon: a meta-analysis of human cadaveric biomechanical studies. Foot (Edinb). 2017;30:13–20.CrossRefGoogle Scholar
Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, et al. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med. 2013;41(12):2867–76.CrossRefGoogle Scholar
Lee SJ, Sileo MJ, Kremenic IJ, Orishimo K, Ben-Avi S, Nicholas SJ, et al. Cyclic loading of 3 Achilles tendon repairs simulating early postoperative forces. Am J Sports Med. 2009;37(4):786–90.CrossRefGoogle Scholar
Guzzini M, Lanzetti RM, Proietti L, Mazza D, Fabbri M, Monaco E, et al. Interlocking horizontal mattress suture versus Kakiuchi technique in repair of Achilles tendon rupture: a biomechanical study. J Orthop Traumatol. 2017;18(3):251–7.CrossRefGoogle Scholar
Kearney RS, McGuinness KR, Achten J, Costa ML. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherapy. 2012;98(1):24–32.CrossRefGoogle Scholar
Groetelaers RP, Janssen L, van der Velden J, Wieland AW, Amendt AG, Geelen PH, et al. Functional treatment or cast immobilization after minimally invasive repair of an acute Achilles tendon rupture: prospective, randomized trial. Foot Ankle Int. 2014;35(8):771–8.CrossRefGoogle Scholar