Acute Achilles Rupture in the Athlete: Current Trends in Management

Abstract

Acute rupture of the Achilles tendon in athletes at all levels of competition represents a devastating injury to the lower extremity with a historically poor rate of return to pre-operative baseline function. Classic management consisting of open extensile repair has been plagued with the risk of post-operative wound healing issues which, although infrequent, can be a disastrous complication with limited options for salvage. As such, recent considerations of functional non-operative rehabilitation have risen in popularity given the avoidance of wound related issues and improved rates of re-rupture compared to classic, immobilized non-operative treatment. Unfortunately, an in-depth analysis of these studies notes concerns regarding residual weakness and functional deficits compared to operative repair. Considering this, the authors propose the use of a “modern day” less invasive technique allowing improved preservation of blood supply to the soft tissues while also limiting the potential for wound healing complications and excess scarring. Furthermore, this technique arguably more reliably regains and maintains tension of the gastrocsoleus complex to the calcaneus during the rehabilitation process compared with functional non-operative and classic open operative repair.