An update on repair of Achilles tendon rupture. Acute and delayed.

Kuwada GT. J Am Podiatr Med Assoc 1999 Jun;89(6):302-6.

Current surgical treatments for Achilles tendon rupture are thoroughly discussed. New repair techniques, such as the use of soft-tissue anchors, are reviewed, as is the use of synthetic mesh to augment the surgical repair. A classification system devised by the author is presented to make it easier to select the appropriate surgical procedure or combination of procedures in delayed rupture repair. Postoperative physical therapy is paramount in the return to preinjury level of activity for these patients.

Diagnosis and treatment of acute ruptures of the Achilles tendon.

Current concepts review. Popovic N, Lemaire R. Acta Orthop Belg 1999 Dec;65(4):458-71.

Subcutaneous rupture of the Achilles tendon seems to have become more common in recent years. This results from a combination of more awareness in the medical field and greater participation in physical activities by the general population. The causes of Achilles tendon rupture are multifactorial and still unclear. The diagnosis can be made based on physical examination; special diagnostic studies are rarely necessary. The literature on ruptures of the Achilles tendon and associated treatment has expanded over the past decade. The lack of a universal, consistent protocol for subjective and objective evaluation following treatment of Achilles tendon rupture has prevented any comparison of results. There is still controversy concerning the best treatment. From a literature review, it appears that a satisfactory outcome may be achieved with either nonoperative or operative treatment but surgical repair appears to provide better functional capacity. Lower rerupture rates and slightly improved strength and functional ability may be expected with surgical treatment; however, the rate of minor complications is higher than with nonoperative treatment. Reports in the literature indicate that in active, young, very demanding individuals, surgical repair should be considered, with nonsurgical treatment reserved for elderly or sedentary patients. There is no single, uniformly accepted surgical technique for Achilles tendon repair. Most acute ruptures have been treated successfully with simple end-to-end suture, although various augmentation procedures have been combined with simple suture with satisfactory outcomes. To minimize the complications typically associated with open surgery, percutaneous techniques to repair the ruptured Achilles tendon have been advocated, and the results are reported to be promising, although not without failures and complications. Several recent studies have reported functional benefits of early postoperative tendon mobilization in well-motivated patients, since treatment results are determined not only by the method of repair but also, and perhaps more importantly, by the early postoperative functional rehabilitation.

Tendo Achillis rupture; surgical repair is a safe option.

Mellor SJ, Patterson MH. Injury 2000 Sep;31(7):489-91.

We reviewed the results of 67 tendo Achillis repairs performed at one District General Hospital over a 5-year period, using details from a comprehensive database. At a mean follow-up of 2.5 years, the re-rupture rate was 3% (2 out of 67). The infection rate was 1.5% (1 out of 67). A review of the relevant literature has revealed that quoted infection rates following tendo Achillis repair vary considerably, and are as high as 21%. Several authors have advised against repair based on those data. In the light of our results, we can recommend surgical repair of tendo Achillis rupture as a safe option.