Chronic Achilles Tendon Ruptures (original) (raw)

How Do Sports Medicine and Foot and Ankle Specialists Treat Acute Achilles Tendon Ruptures?

Foot & Ankle Specialist, 2020

Background. The purpose of this study is to evaluate the treatment considerations and surgical techniques utilized by fellowship-trained orthopaedic sports medicine and foot and ankle specialists in the management of Achilles tendon ruptures. Methods. A blinded electronic survey was distributed to 2062 fellowship-trained sports medicine and 1319 fellowship-trained foot and ankle orthopaedic surgeons. The total number of acute Achilles tendon ruptures managed per year, patient-specific factors associated with surgical decision making and surgical techniques were evaluated. Results. Of the 3381 surveys distributed, 524 responses were included for analysis. Only 9% of respondents manage more than 20 acute Achilles tendon ruptures per year with the majority (75%) managing less than 10 per year. Operative management is the treatment of choice for 76% of total respondents with only 8% managing acute ruptures nonoperatively. Activity level and patient age were the single most important fac...

Case series-spontaneous chronic Tendo Achilles (TA) rupture and management

National Journal of Clinical Orthopaedics

Although being the strongest tendon in the body, the Achilles tendon is the most frequently ruptured tendon in the lower limb and comprises approximately 20% of all large tendon ruptures. The classical site of rupture is generally 3cm-6cm proximal to its insertion into the calcaneal tuberosity, as there is a hypo vascular zone present in this area of tendon. The most common mechanism usually involves eccentric loading on a dorsiflexed ankle with the knee extended (soleus and gastrocnemius on maximal stretch. A bilateral Tendo Achilles rupture is uncommon, and for it to occur spontaneously is notably rare (1%). Risk factors for spontaneous TA ruptures includes local Corticosteroid use Quinolone antibiotics (ciprofloxacin), previous tendon rupture, Systemic disease (like gout, hypothyroidism, diabetes, tuberculosis, gonorrhea, syphilis, systemic lupus erythematosus, rheumatoid arthritis), Ageing, Increased BMI and Primary Achilles tendon tumors etc. Described are the 10 feet (8 patients), two had bilateral presentation. All came after 3 weeks of injury and treated with debridement, V-Y plasty and FHL (flexor Hallucis Longus) transfer. All patients regained full movements at the ankle and resume their routine activities at 3 months follow-up.

Treatment of the Neglected Achilles Tendon Rupture

Clinics in Podiatric Medicine and Surgery, 2012

Achilles tendon rupture occurs frequently and if not managed appropriately may result in significant disability. Prompt diagnosis of an acute rupture and early initiation of treatment generally lead to optimal results. Acute Achilles tendon ruptures may be missed or misdiagnosed up to 25% of the time 1 or the patient may not seek immediate medical care because they are still able to ambulate and the pain is tolerable. A delay in treatment worsens the outcome and treatment options become more limited. This article focuses on the treatment options for the neglected Achilles tendon rupture. The Achilles tendon is the largest tendon in the human body. It is made up of a confluence of tendinous contributions from the gastrocnemius and soleus muscles. This complex is known as the triceps surae. The plantaris muscle is also found in the posterior aspect of the leg, originating on the lateral condyle of the femur, and forms a tendon that passes between the gastrocnemius and soleus and runs medial to the Achilles tendon and inserts directly onto the posterior aspect of the calcaneus. The gastrocnemius, the largest of the 3, is composed of a medial and lateral head. The muscle originates on the posterior aspect of the femoral condyle and courses distally to span 3 joints (knee, ankle, and subtalar joint). Therefore, the position of each of these joints influences the tension placed across the gastrocnemius muscle-tendon unit. 2 The fibers of the gastrocnemius form an aponeurosis with the muscle fibers posterior. The soleus muscle originates from the posterior aspect of the tibia and fibula below the knee and therefore only the ankle and subtalar joint affect the tension across this muscle-tendon unit. The fibers unite to form an aponeurosis with the muscle fibers anterior. The combined aponeuroses of gastrocnemius and soleus converge to form the Achilles tendon, which inserts on the central one-third of the posterior aspect of the calcaneus. The Achilles tendon is the strongest and thickest tendon in the human body and can be subjected to loads 2 to 3 times the body weight when walking and up to 10 times the body weight with certain athletic activities. 3,4 Most Achilles ruptures are a result of indirect trauma, either by a sudden stretch (eccentric loading) or a forceful contraction

Results of surgical versus non-surgical treatment of Achilles tendon rupture

International Orthopaedics, 2004

patients with acute Achilles tendon rupture were admitted to our institution. Depending on the day of admission patients were allocated either to the Department of Trauma Surgery or to the Department of Orthopaedics. Two hundred and twelve patients (mean age 37±9.4 years) were treated with surgical suture followed by plaster for 6 weeks. Eighty patients were treated non-surgically with splinting for 12 weeks. For both groups mean follow-up was 6±3 years. There were 14 re-ruptures, ten after surgical repair and four after non-surgical treatment. In the surgical group there were seven major wound problems, 11 minor wound complications and six patients with complaints from the sural nerve. In the non-surgical group one patient suffered a pulmonary embolism after a re-rupture, 3 months after the initial rupture. There was no difference in mean ankle score and patient-satisfaction score between groups. Only 52% regained their original sports activity level, slightly better in the surgically treated group. With a nonsignificant difference in re-rupture rate but relatively more complications after surgical repair, non-surgical treatment is preferred. With a slightly better recovery of sports activity after surgical repair, this might be used as an argument for surgical treatment in young athletes. Résumé Entre 1990 et 2001, 292 malades avec une rupture du tendon d'Achille ont été admis dans notre institution. Selon le jour de l'admission les malades ont été alloués au Département de Traumatologie ou au Département d'Orthopédie. 212 malades (âge moyen 37±9,4 ans) ont été traité par suture chirurgicale suivie d'un plâtre pour 6 semaines et 80 malades ont été traités conservativement avec attelle pour 12 semaines. Pour les deux groupes la moyenne de suivi était de 6±3 années. Il y avait 14 ruptures itératives, 10 après réparation chirurgicale et quatre après traitement non chirurgical. Dans le groupe chirurgical il y avait sept problèmes majeurs de paroi, 11 complications mineures de paroi et six malades avec souffrance du nerf sural. Dans le groupe non chirurgical un malade a eu une embolie pulmonaire après une rupture itérative, trois mois après la rupture initiale. Il n'y avait aucune différence dans le score moyen de la cheville et le score de satisfaction des malades entre les deux groupes. Seulement 52% ont regagné leur niveau d'activité sportive original, légèrement mieux dans le groupe traité chirurgicalement. Avec une différence non significative dans le taux des ruptures itératives mais relativement plus de complications après réparation chirurgicale, le traitement non -chirurgical est préféré. La récupération sportive légèrement meilleure après réparation chirurgicale est un élément de discussion pour le traitement chirurgical chez les jeunes athlètes.

Management of chronic Achilles ruptures: a scoping review

International Orthopaedics, 2021

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 p...

Chronic Achilles Tendon Rupture

The Open Orthopaedics Journal

Background: The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries. Methods: This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed. Results: The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results. Conclusion: The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open...