Management of chronic Achilles ruptures: a scoping review

Abstract

Purpose This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research. Methods A scoping review was performed according to the frameworks of Arksey and O’Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria. Results A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%). Conclusion Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient.

Achilles Tendon Injuries Requiring Surgical Treatment in the Pediatric and Adolescent Population: A Case Series

“…com/CSMR/A126, http://links.lww.com/CSMR/A127 and http://links.lww.com/CSMR/A128) (33). In the adult population, chronic Achilles tendon ruptures (commonly defined as presenting at least 4 wk after injury) (34) often result in significant pain and functional deficit as well as more challenging operative repair, necessitating techniques, such as flexor hallucis longus (FHL) transfer or V-Y plasty (35). FHL transfer was discussed but not ultimately performed in one patient in our series.…”

Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment – a case series

“…Despite the fact that CATR occurs in up to one in four patients with ATR, there is currently limited knowledge with regard to the outcomes after surgical treatment [ 1 , 13 , 25 ]. Previous literature reports that impairments in ankle-related function may persist for several years after surgical treatment of CATR, but there is a widespread use of non-validated outcome measures [ 1 , 3 ]. The aim of this study was to evaluate the one-year postoperative outcomes in patients with CATR using a comprehensive battery including several validated tests.…”

Electrospun, Resorbable, Drug-Eluting, Nanofibrous Membranes Promote Healing of Allograft Tendons

“…The rate of misdiagnosis or delayed diagnosis can be as high as 25% [ 2 , 3 ]. Chronic injury may occur 4–6 weeks after initial injury [ 4 , 5 ]. Surgical treatment for primary repair is feasible in acute injury, but not in chronic injury due to the retraction of the injured tendon and superimposed fibrous tissue.…”