Achilles tendon rupture – treatment and complications: A systematic review

Abstract

Achilles tendon rupture is a frequent injury with an increasing incidence. Until now, there is no consensus regarding optimal treatment. The aim of this review was to illuminate and summarize randomized controlled trials comparing surgical and non-surgical treatment of Achilles tendon ruptures during the last 10 years. Seven articles were found and they were all acceptable according to international quality assessment guidelines. Primary outcomes were re-ruptures, other complications, and functional outcomes. There was no significant difference in re-ruptures between the two treatments, but a tendency to favoring surgical treatment. Further, one study found an increased risk of soft-tissue-related complications after surgery. Patient satisfaction and time to return to work were significantly different in favor of surgery in one study, and there was also better functional outcome after surgery in some studies. These seven studies indicate that surgical patients have a faster rehabilitation. However, the differences between surgical and non-surgical treatment appear to be subtle and it could mean that rehabilitation is more important, rather than the actual initial treatment. Therefore, further studies will be needed in regard to understanding the interplay between acute surgical or non-surgical treatment, and the rehabilitation regimen for the overall outcome after Achilles tendon ruptures.

Percutaneous repair of the Achilles tendon rupture in athletic population

“…Although there is an argument whether surgical or non-surgical treatment is the best option, operation appears to be more suitable for athletes due to the faster return to previous activities and the lower rerupture rate. [6][7][8] Percutaneous suturing of the AT was first introduced by Ma and Griffith in 1977 9 as an alternative for open repair, in order to avoid the procedure's complications. Since then, much progress has been made.…”

The "2-2-2" Early Mobilization Protocol in Achilles Tendon Rupture: A Pilot Case Series

“…Future studies would compare different functional rehabilitation programs to the 2-2-2 protocol, while focusing on function, compliance, and cost-effectiveness. More importantly, a randomized controlled trial comparing surgical repair to other conservative rehabilitation programs such as the 2-2-2 protocol would allow a direct assessment of treatment efficacy, perhaps revealing that surgery may not be required to treat acute Achilles tendon rupture [1,[4][5][6].…”

“…To this day, a consensus has yet to be reached within the orthopedic community for treatment of acute Achilles tendon rupture [1,2]. Defenders of the classical surgical tendon re-approximation approach argue superior benefits for young and active patients; lower re-rupture rates and a faster return to activities [3].…”

“…Defenders of the classical surgical tendon re-approximation approach argue superior benefits for young and active patients; lower re-rupture rates and a faster return to activities [3]. Recent evidence, however, suggests that a conservative approach, in the form of a well-structured rehabilitation program focused on intensive early mobilization, can achieve results that are comparable to surgical treatment, while also avoiding the risks of operative complications such as infection and soft-tissue related complications [1,[4][5][6]. Nevertheless, conservative treatment protocols as currently reported in the literature pose a challenge to patients, physicians and physical therapists for being time-consuming, as well as having the potential for both poor compliance and loss to follow-up [6].…”

Image Stitching for Achilles Tendon Ultrasonography Using Particle Swarm Optimization of Boundary Vector Field Based Similarity and Log-Domain Diffeomorphic Registration

“…The Achilles tendon (AT) is the longest and strongest tendon in the human body [1,2]. AT injuries consist of Achilles tendinopathies and tendon ruptures, which can dramatically affect the life quality of a patient [3,4].…”