Management of chronic Achilles tendon ruptures

Abstract

Achilles tendon ruptures are fairly common injuries that are often unfortunately missed, leading to the development of chronic tendoachilles (TA) ruptures. Patients present with gait abnormalities and significant ankle plantarflexion weakness. Imaging modalities such as ultrasound (US) and magnetic resonance imaging (MRI) are used to confirm the diagnosis and help in surgical planning. Most chronic TA ruptures require surgical management, with non-operative management being reserved for medically unfit patients due to generally poor outcomes. A multitude of surgical reconstruction options have been described in the literature, each with its benefits and disadvantages. Ultimately, the choice of surgical technique depends on the residual gap that is present following debridement of the scar tissue that forms a bridge between the ruptures ends of the Achilles tendon, graft availability and the treating surgeon's preference. Surgery results in an improvement in patient-reported outcomes, with the majority going back to their pre-injury level activities. However, surgery is also associated with a fair number of complications, the most common being wound healing problems, infections, neurological injury and deep vein thromboses for which patients need to be appropriately counselled for.