The ruptured Achilles tendon: a current overview from biology of rupture to treatment

Abstract

The Achilles tendon (AT) is the most frequently ruptured tendon in the human body yet the aetiology remains poorly understood. Despite the extensively published literature, controversy still surrounds the optimum treatment of complete rupture. Both non-operative management and percutaneous repair are attractive alternatives to open surgery, which carries the highest complication and cost profile. However, the lack of a universally accepted scoring system has limited any evaluation of treatment options. A typical UK district general hospital treats approximately 3 cases of AT rupture a month. It is therefore important for orthopaedic surgeons to correctly diagnose and treat these injuries with respect to the best current evidence-based practice. In this review article, we discuss the relevant pathophysiology and diagnosis of the ruptured AT and summarize the current evidence for treatment.

Achilles tendon ruptures

“…It should be noted that a very forceful calf squeeze may recruit the deep compartmental musculature and yield a false negative result. False positives can occur when the patient has an intact plantaris tendon [28]. In the authors' experience, this test can also yield a false positive in the setting of a chronic rupture, where scar tissue and fibrosis of the paratenon can mimic continuity between the gastroc-soleus muscle belly and the calcaneus.…”

Endothelial dysfunction and tendinopathy: how far have we come?

“…Evidences showed how load and microinjury of the Achilles tendon structure from continuous involvement can result in a partially damaged tendon where the injured portions unload and the remaining intact portions consequently bear most of the force applied [36]. Also the optimum treatment of complete rupture of Achilles tendon has not been established yet, the most frequently ruptured tendon in the human body [22,35].…”

Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

“…A n Achilles tendon (AT) rupture is the most frequent tendon injury in the lower limb, with an incidence of 18 per 100 000 individuals each year, [1][2][3][4][5] most of whom are middle-aged [5][6][7] male amateur athletes. 1,8 Tendinous overload 6,9 and a nonuniform distribution of stress 10 promoted by neuromuscular imbalance 11 or pathologic muscular conditions 12 are mechanical factors that contribute to an AT rupture.…”

“…The other begins with some degree of immobilization or non-weight bearing in the first 4 weeks after AT repair, normally via a rest period during the first 2 weeks after surgery. 21 Currently, managing AT rehabilitation after operative repair remains controversial 1,2,4,5,8,16,22 because of the unknown mechanical tolerances of different operative techniques 4,6 for preventing clinical failure 22 ; the comorbidities associated with traditional management, [3][4][5][6]8,14,16,22 such as muscle atrophy, adherences, delayed collagen remodeling, thromboembolism, and high rerupture rates [2][3][4][5][6]22,23 ; and the risks and complications that can occur during early rehabilitation, 3,4,6,15,21,22 such as tendinous elongation and early reruptures. 3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,…”

“…3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,[21][22][23] to promote better clinical outcomes than are typical with open or traditional rehabilitation programs. 3,5,6,8,10,16,22,23 Traditional models do not appear to provide the tissue and neuromuscular benefits that early models provide. 3,6,10,16,[21][22][23] Indeed, they result in pathologic adaptations to plantar-flexion tasks.…”