J Korean Foot Ankle Soc.  2015 Sep;19(3):77-80. 10.14193/jkfas.2015.19.3.77.

Treatment of Acute Achilles Tendon Rupture

• Lee TH
• Kim HJ
• Jeon YS

• KMID: 2045008
• DOI: http://doi.org/10.14193/jkfas.2015.19.3.77

Abstract

Acute Achilles tendon rupture is a frequent injury during sports and recreational activities. Treatments for Achilles tendon rupture have been controversial in recent decades. Traditionally the surgical treatment had benefit over nonsurgical treatment in terms of low rerupture rate and early functional restoration. Recently, nonsurgical treatment was found to show no statistically significant inferiority in re-rupture rate, functional outcome, and calf strength. Whereas, surgical treatment had some complications including adhesion, nerve injury, and infection. Nonsurgical treatment has been increasing due to functional rehabilitation with early weight bearing and restricted early motion. It focuses more attention on the course of caring for patients with deep discussion. There are open repair and minimally invasive repair in terms of surgical treatment. There are various techniques for minimally invasive repair of Achilles tendon, which has some advantages over the open repair. However, the optimal technique for minimally invasive repair has not been established. The number of suture strands is important regardless of suture technique.

Keyword

Achilles tendon; Rupture; Treatment; Surgical; Nonsurgical

MeSH Terms

Achilles Tendon*
Humans
Rehabilitation
Rupture*
Sports
Suture Techniques
Sutures
Weight-Bearing

Figure

• 

  Figure 1. Radiographic findings of Achilles tendon rupture. (A) Loss of Kager's triangle was seen in simple radiograph (arrow). (B) Loss of fibercon-tinuation and hypoechogenicity were seen in ultrasonography (arrow). (C) Achilles tendon rupture was seen in magnetic resonance image (arrow).

• 

  Figure 2. Functional hinged brace was applied to a patient with Achilles tendon rupture for early weight bearing and restricted ankle motion.

• 

  Figure 3. (A) This is a schematic drawing showing Krackow suture technique for Achilles tendon repair. (B) This is a schematic drawing showing Bunnell suture technique for Achilles tendon repair. (C) This is a schematic drawing showing Kessler suture technique for Achilles tendon repair.

Reference

References

1. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture1 A prospective randomized study and review of the literature. Am J Sports Med1. 1993; 21:791–9.

2. Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes Am J Sports Med1. 2002; 30:287–305.

3. Leppilahti J, Orava S. Total Achilles tendon rupture. A review1 Sports Med1. 1998; 25:79–100.

4. Kongsgaard M, Aagaard P, Kjaer M, Magnusson SP. Structural Achilles tendon properties in athletes subjected to different exercise modes and in Achilles tendon rupture patients. J Appl Physiol (1985)1. 2005; 99:1965–71.

5. Rettig AC, Liotta FJ, Klootwyk TE, Porter DA, Mieling P. Potential risk of rerupture in primary achilles tendon repair in athletes younger than 30 years of age. Am J Sports Med1. 2005; 33:119–23.

6. Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med1. 1978; 6:107–11.

7. Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis1 Am J Sports Med. 2002; 30:783–90.

8. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a metaanalysis of randomized trials1 J Bone Joint Surg Am. 2012; 94:2136–43.

9. Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc1. 2008; 16:204–9.

10. McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon1 Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg Am1. 1997; 79:1799–808.

11. Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles tendon rupture: 196 consecutive patients with a 7% rerupture rate. Acta Orthop. 2005; 76:597–601.

12. Sorrenti SJ. Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair. Foot Ankle Int. 2006; 27:407–10.

13. Ding WG, Li H, Zhu YP, Liu ZW. Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture. Foot Ankle Surg. 2014; 20:105–8.

14. McMahon SE, Smith TO, Hing CB. A metaanalysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg. 2011; 17:211–7.

15. Ko ł odziej L, Bohatyrewicz A, Kromuszczyńska J, Jezierski J, Biedroń M. Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study–preliminary report. Int Orthop. 2013; 37:625–9.

16. Nistor L. Surgical and nonsurgical treatment of Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am. 1981; 63:394–9.

17. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010; 38:2186–93.

18. Jiang N, Wang B, Chen A, Dong F, Yu B. Operative versus nonoperative treatment for acute Achilles tendon rupture: a metaanalysis based on current evidence. Int Orthop. 2012; 36:765–73.

19. Holm C, Kjaer M, Eliasson P. Achilles tendon rupture–treatment and complications: a systematic review. Scand J Med Sci Sports. 2015; 25:e1–10.

20. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res. 1977; 128:247–55.

21. Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999; 81:877–80.

22. Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon1 Knee Surg Sports Traumatol Arthrosc. 2008; 16:199–203.

23. Ozsoy MH, Cengiz B, Ozsoy A, Aksekili MA, Yucel M, Fakioglu O, et al. Minimally invasive Achilles tendon repair: a modification of the Achillon technique. Foot Ankle Int. 2013; 34:1683–8.

24. Wang CC, Chen PY, Wang TM, Wang CL. Ultrasound-guided minimally invasive surgery for achilles tendon rupture: preliminary results. Foot Ankle Int. 2012; 33:582–90.

25. Kong GM, Gwak HC, Kim JG. A comparative study of surgical treatment in the ruptured achilles tendon: minimal incision and open repair. J Korean Foot Ankle Soc. 2012; 16:181–9.

26. Kim DY, Kim SB, Heo YM, Lee JB, Lim JW, Oh HT. Surgical treatment of the ruptured achilles tendon: a comparative study between percutaneous and open repair. J Korean Foot Ankle Soc. 2011; 15:79–85.

27. Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. Br Med Bull. 2014; 109:45–54.

28. Watson TW, Jurist KA, Yang KH, Shen KL. The strength of Achilles tendon repair: an in vitro study of the biomechanical behavior in human cadaver tendons. Foot Ankle Int. 1995; 16:191–5.

29. Kim HN, Park KH, Park YW. Treatment of acute achilles tendon rupture using krackow suture technique1 J Korean Foot Ankle Soc. 2009; 13:34–9.

30. McCoy BW, Haddad SL. The strength of achilles tendon repair: a comparison of three suture techniques in human cadaver tendons. Foot Ankle Int. 2010; 31:701–5.