Conservative, minimally invasive and open surgical repair for management of acute ruptures of the Achilles tendon: a clinical and functional retrospective study

Abstract

Background: Achillodynia is common and includes Achilles tendinopathy, partial Achilles tears and Achilles tendon ruptures. However, we believe an additional pathology should be considered for Achillodynia differentials -the intratendinous tear (ITT). Methods: Examinations of 740 achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively. Results: 5% (29 males, 8 females) of 740 patients had an ITT. Patients typically presented with a history of sudden onset localised pain and the ability to train but not reach maximal loading. Average age was 36. 3 years (range 20-64), significantly lower than mid-tendon tendinopathy (8.48 years; p<0.01). 92% had concurrent Achilles tendinopathy. Elite sportspeople were more highly represented in the ITT than mid-tendon tendi nopathy groups (86.2% ITT group vs 13.8% mid-tendon AT group; p<0.01). Conclusions: ITTs should be actively searched for in patients with Achilles pathology, especially in elite male athletes with a history of high-impact pain. Prospective research is warranted concerning diagnosis and management. Level of evidence: IV.

Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

“…A post-operative protocol described by Maffulli et al [ 94 ] let patients to be discharged the same day of the operation and allowed them to bear weight on the metatarsal heads of the operated leg using elbow crutches as tolerated. An orthopedic physiotherapist should instruct the patient to use crutches.…”

Expression of TGF‑β1 and VEGF in patients with Achilles tendon rupture and the clinical efficacy

“…Some people advocate conservative treatment, while others surgical treatment, both of which have positive effects (20). However, a study has shown that surgical treatment reduces the incidence of re-rupture of Achilles tendon (21), therefore surgical treatment is considered to be slightly superior to conservative treatment.…”

ACFAS Clinical Consensus Statement: Acute Achilles Tendon Pathology

“…Although some of the recent literature credits percutaneous repair with having fewer postoperative complications, the overall functional outcome remains more favorable when treated via an open technique. Despite postoperative concerns for acute Achilles tendon rupture treated with open repair, it continues to have decreased tendon rerupture rates (75,81,87−89), lower rates of decreased calf circumference (77), and decreased incidence of sural neuritis (77,78,85). Based on the findings from the majority of recent literature published, it is inappropriate to depict percutaneous repair of acute Achilles tendon ruptures as having better overall functional outcomes compared with traditional open repair.…”