Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 9 , ISSUE 3 ( July-September, 2022 ) > List of Articles

EXPERT VIEW

Current Concepts in Acute Achilles Tendon Injury

Amit Bishnoi, Maneesh Bhatia

Keywords : Achilles tendon, Achilles tendon repair, Achilles tendon rupture

Citation Information : Bishnoi A, Bhatia M. Current Concepts in Acute Achilles Tendon Injury. J Foot Ankle Surg Asia-Pacific 2022; 9 (3):130-134.

DOI: 10.5005/jp-journals-10040-1260

License: CC BY-NC 4.0

Published Online: 01-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Tendon Achilles injury is a common foot and ankle injury in the middle-aged population, especially between the age group of 30–46 years. This is important to recognize early and treat as salvage options have consistently poor outcomes. The incidence of acute tendon rupture (ATR) is on rising worldwide. Men are more prone to ATR when they try to get back to some fitness in the middle ages by playing dynamic sports like badminton, tennis, etc. We looked at the current concepts in the management of acute tendon Achilles injury. Method: We looked at the evidence of management, both surgical and nonsurgical options in detail and discussed the pros and cons of each modality. There are both advantages and disadvantages but the new evidence is tilting toward functional rehabilitation. Conclusion: This provides a systemic approach to clinicians in decision-making about the management of ATR in their patient group and recommends functional treatment as our choice in the majority of patient groups.


PDF Share
  1. Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand 1996;67(3):277–279. DOI: 10.3109/17453679608994688
  2. Moller M, Movin T, Granhed H, et al. Acute rupture of the tendon Achilles. A Prospective randomized study of comparison between surgical and non surgical treatment. J Bone Joint Surg 2001;83(6):843–848. DOI: 10.1302/0301-620x.83b6.11676
  3. Curwin S, Standish WD. Tendonitis: its etiologyand treatment. Lexington (MA): Collamore Press; 1984
  4. Cummings EJ, Anson BJ, Carr BW, et al. The structure of calcaneal (Achilles) in relation to orthopaedic surgery. Surg Gynaecol Obst 1946;83:107–116.
  5. Nillius SA, Nilsson B, Westlin N. The incidence of Achilles tendon rupture. Acta Orthop Scand 1976;47(1):118–121. DOI: 10.3109/17453677608998983
  6. Saltzman CL, Tearse DS. Achilles tendon injuries. J Am Acad Orthop Surg 1998;6(5):316–325. DOI: 10.5435/00124635-199809000-00007
  7. Maffuli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prostective study in 174 patients. Am J Sports Med 1998;26:266–270. DOI: 10.1177/03635465980260021801
  8. Rockett MS, Waitches G, Sudakoff G, et al. Use of ultrasonography versus magnetic resonance imaging for tendon abnormalities around the ankle. Foot Ankle Int 1998;19(9):604–612. DOI: 10.1177/1 07110079801900907
  9. Pajala A, Kangas J, Siira P, et al. Augmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am 2009;91(5):1092–1100. DOI: 10.2106/JBJS.G.01089
  10. Sadoghi P, Rosso C, Valderrabano V, et al. Initial Achilles tendon repair strength–synthesized biomechanical data from 196 cadaver repairs. Int Orthop 2012;36(9):1947–1951. DOI: 10.1007/s00264-012-1533-6
  11. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res 1977;(128):247–255. PMID: 340096.
  12. Lim J, Dalai R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int 2001;22(7):559–568. DOI: 10.1177/107110070102200705
  13. Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br 1999;81(5):877–880. DOI: 10.1302/0301-620x.81b5.9784
  14. Wagnon R, Akayi M. The Webb–Bannister percutaneous technique for acute Achilles’ tendon ruptures: a functional and MRI assessment. J Foot Ankle Surg 2005;44(6):437–444. DOI: 10.1053/j.jfas.2005.07.015
  15. Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland: a 15 year study. Clin J Sport Med 1999;9(3):157–160. DOI: 10.1097/00042752-199907000-00007
  16. Carmont MR. Achilles tendon rupture: the evaluation and outcome of percutaneous and minimally invasive repair. Br J Sports Med 2018;52(19):1281–1282. DOI: 10.1136/bjsports-2017-099002
  17. Keller A, Ortiz C, Wagner E, et al. Mini-open tenorrhaphy of acute Achilles tendon ruptures: medium-term follow-up of 100 cases. Am J Sports Med 2014;42(3):731–736. DOI: 10.1177/0363546513511418
  18. Cretnik A, Zlajpah L, Smrkolj V, et al. The strength of percutaneous methods of repair of the Achilles tendon: a biomechanical study. Med Sci Sports Exerc 2000;32(1):16–20. DOI: 10.1097/00005768-200001000-00004
  19. Henríquez H, Muñoz R, Carcuro G, et al. Is percutaneous repair better than open repair in acute Achilles tendon rupture. Clin Orthop Relat Res 2012;470(4):998–1003. DOI: 10.1007/s11999-011-1830-1
  20. Kangas J, Pajala A, Siira P, et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 2003;54(6):1171–1180. DOI: 10.1097/01.TA.0000047945.20863.A2
  21. Suchak AA, Bostick GP, Beaupré LA, et al. The influence of early weight–bearing compared with non–weight–bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am 2008;90(9):1876–1883. DOI: 10.2106/JBJS.G.01242
  22. De la Fuente C, y Lillo RP, Carreño G, et al. Prospective randomized clinical trial of aggressive rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique. Foot (Edinb) 2016;26:15–22. DOI: 10.1016/j.foot.2015.10.003
  23. Aibinder WR, Patel A, Arnouk J, et al. The rate of sural nerve violation using the Achillon device: a Cadaveric study. Foot Ankle Int 2013;34(6):870–875. DOI: 10.1177/1071100712473097
  24. Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ 2019;364:k5120. DOI: 10.1136/bmj.k5120
  25. Lawrence JE, Nasr P, Fountain DM, et al. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J 2017;99-B(1):87–93. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0452.R1
  26. Hufner TM, Brandes DB, Thermann H, et al. Long–term results after functional nonoperative treatment of achilles tendon rupture. Foot Ankle Int 2006;27(3):167–171. DOI: 10.1177/107110070602700302
  27. Costa ML, Achten J, Marian LR, et al. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomized control trial and economic evaluation. Lancet 2020;395(10222):441–448. DOI: 10.1016/S0140-6736(19)32942-3
  28. Hutchison AM, Topliss C, Beard D, et al. The treatment of a rupture of the Achilles tendon using a dedicated management programme. Bone Joint J 2015;97–B(4):510–515. DOI: 10.1302/0301-620X.97B4.35314
  29. Aujla RS, Patel S, Jones A, et al. Non-operative functional treatment for acute Achilles tendon ruptures: the Leicester Achilles Management Protocol (LAMP). Injury 2019;50(4):995–999 DOI: 10.1016/j.injury.2019.03.007
  30. Khan RJ, Caery Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane database Syst rev 2010;(9):CD003674. DOI: 10.1002/14651858.cd003674.pub4
  31. Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo-Achilles: a prospective randomized evaluation of functional outcomes. J Bone Joint Surg Br 2011;93(8):1071–1078. DOI: 10.1302/0301-620X.93B8.25998
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.