Achilles Tendon Injuries: Comparison of Different Conservative and Surgical Treatment and Rehabilitation
Article Sidebar
Main Article Content
Abstract
Despite its high incidence and the great development of literature, there is still controversy about the optimal management of Achilles tendon rupture. The several techniques proposed to treat acute ruptures can essentially be classified into: conservative management (cast immobilization or functional bracing), open repair, minimally invasive technique and percutaneous repair with or without augmentation. Although chronic ruptures represent a different chapter, the ideal treatment seems to be surgical too (debridement, local tissue transfer, augmentation and synthetic grafts). In this paper we reviewed the literature on acute injuries.
Article Details
Copyright (c) 2017 Bistolfi A, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Fox G, Gabbe BJ, Richardson M, Oppy A, Page R, et al. Twelve-month outcomes following surgical repair of the Achilles tendon. Injury. 2016; 47: 2370-2374. Ref.: https://goo.gl/uvAwcY
Leppilahti J, Forsman K, Puranen J, Orava S. Outcome and prognostic factors of Achilles rupture repair using a new scoring method. Clin Orthop Rel Res. 1998; 346: 152-161. Ref.: https://goo.gl/hMXguu
Maffulli N, Adam A, Giuseppe UL, Denaro V. Chronic rupture of tendo Achillis. Foot Ankle Clinic. 2007; 12: 583-596. Ref.: https://goo.gl/tr6I6F
Jennings AG, Sefton GK. Chronic rupture of tendo Achillis. Long-term results of operative management using polyester tape. J Bone Joint Surg Br. 2002; 84: 361-363. Ref.: https://goo.gl/WL4zhx
The Foot and Ankle. Philadelphia, PA: Lippincott Williams & Wilkins, 2002; 323-335.
Rook MD. Lesione dei tendini, dei vasi, dei nervi e della cute. In: Verduci (ed) Chirurgia del Piede. 1996; 32: 497-501.
Maffulli N. Rupture of the Achilles tendon. Current concepts review. J Bone Joint Surg Am. 1999; 81: 1019-1036. Ref.: https://goo.gl/XW22Sc
Sudheer SR, Pedowitz DI, Parekh SG, Omar IM, Wapner KL. Surgical treatment for chronic disease and disorders of the Achilles tendon. J Am Acad Orthop Surg. 2009; 17: 3-14. Ref.: https://goo.gl/IhGr4z
Möller M, Kälebo P, Tidebrant G, Movin T, Karlsson J. The ultrasonographic appearance of the ruptured Achilles tendon during healing: a longitudinal evaluation of surgical and nonsurgical treatment, with comparisons to MRI appearance. Knee Surg Sports Traumatol Arthrosc. 2002; 10: 49-56. Ref.: https://goo.gl/j20U9T
Möller M, Movin T, Granhed H, Lind K, Faxe´n E et al. Acute rupture of tendon Achillis. A prospective randomized study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br. 2001; 83: 843-848. Ref.: https://goo.gl/7KWHkD
Nistor L. Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am. 1981; 63: 394-399. Ref.: https://goo.gl/To8tpn
Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993; 21: 791-799. Ref.: https://goo.gl/KwDeyX
Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2004; 3: CD003674. Ref.: https://goo.gl/PagsGs
Zandbergen RA, de Boer SF, Swierstra BA, Day J, Kleinrensink GJ, et al. Surgical treatment of Achilles tendon rupture. Examination of strength of 3 types of suture techniques in a cadaver model. Acta Orthopaedica. 2005; 76: 408-411. Ref.: https://goo.gl/2ILxrn
Yildirim Y, Esemenli T. Initial pull-out strength of tendon sutures: an in vitro study in sheep Achilles tendon. Foot Ankle Int. 2002; 23: 1126-1130. Ref.: https://goo.gl/GC9VwF
Kessler I. The grasping technique for tendon repair. Hand. 1973; 5: 253-255. Ref.: https://goo.gl/yunRbX
Bradley JP, Omodio LG, Crider JR. Achilles tendon ruptures. Intraoperative techniques for repair. Aorn J. 1992; 55: 994-1008. Ref.: https://goo.gl/9dex7x
Steele GJ, Harter RA, Ting AJ. Comparison of fuctional ability following percutaneous and open surgical repairs of acutely ruptured Achilles tendons. J Sports Rehab. 1993; 2: 115-127. Ref.: https://goo.gl/255IeR
Tang KL, Thermann H, Dai G, Chen GX, Guo L, et al. Arthroscopically assisted percutaneous repair of fresh closed Achilles tendon rupture by Kessler’s suture. Am J Sports Med. 2007; 35: 589-596. Ref.: https://goo.gl/1BTFfS
Lansdaal JR, Goslings JC, Reichart M, Govaert GAM, van Scherpenzeel KM, et al. The results of 163 Achilles tendon ruptures treated by minimally invasive surgical technique and functional after-treatment. Injury. 2007; 38: 839-844. Ref.: https://goo.gl/y1P5SQ
Gigante A, Moschini A, Verdenelli, Torto DM, Ulisse S, et al. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sport Traumatol Arthrosc. 2008; 16: 204-209. Ref.: https://goo.gl/JbFiOM
Assal M, Jung M, Stern R, Rippstein P, Delmi M, et al. Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002; 84: 161-170. Ref.: https://goo.gl/ndW26p
Adam CS, Mark MC. Achilles Tendon Rehabilitation. Foot Ankle Clin. 2009; 14: 773-782. Ref.: https://goo.gl/QSOgQS
Maffulli N, Cheryl T, Jason W, Kim Peng L, Robert B. Early weightbearing and Ankle Mobilization after open repair of Acute Midsubstance Tears of the Achilles tendon. The American Journal of Sports Medicine. 2003; 31: Ref.: https://goo.gl/z7na1U
Postacchini F, Puddu G. Subcutaneous ruptures of the Achilles Tendon. Int Surg. 1976; 61: 14-18. Ref.: https://goo.gl/Equ0Vd
Nyyssonen T, Luthje P. Kroger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg. 2008; 97: 272-275. Ref.: https://goo.gl/Ry1N2m
Suchak AA, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 2005; 26: 932-936. Ref.: https://goo.gl/pJA9Dz
Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle. 1985; 6: 34-38. Ref.: https://goo.gl/MVlWhx
Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weight-bearing: a randomized controlled trial. Am J Sports Med. 2008; 36: 1688-1694. Ref.: https://goo.gl/Zl1OTr
Thompson J, Bavarian B. Acute and chronic Achilles tendon ruptures in Athletes. Clin Podiatr Med Surg. 2011; 28: 117-135. Ref.: https://goo.gl/Zn3PzD
Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: A prospective randomised evaluation of functional outcome. J Bone Joint Surg Br. 2011; 93: 1071-1078. Ref.: https://goo.gl/eUHMYZ
Gwynne-Jones DP, Sims M, Handcock D. Epidemiology and outcomes of acute Achilles tendon rupture with operative or non-operative treatment using an identical functional bracing protocol. Foot Ankle Int. 2011; 32: 337-343. Ref.: https://goo.gl/uthZSX
Wilson AM, Goodship AE. Exercise-induced hyperthermia as a possibile mechanism for tendon degeneration. J Biomech. 1994; 27: 899-905. Ref.: https://goo.gl/2okq0u
Birch HL, Wilson AM, Goodship AE. The effect of exercise-induced localised hyperthermia on tendon cell survival. J Exp Biol. 1997; 200: 1703-1708. Ref.: https://goo.gl/vZFOYw
DeLee J, Drez D, Miller MD. DeLee & Drez’s orthopaedic sports medicine. 2nd edition. Philadelphia: Saunders; 2003.
Paavola M, Kannus P, Järvinen TAH, Khan K, Józsa L, et al. Achilles tendinopathy. J Bone Joint Surg Am. 2002; 84: 2062-2076. Ref.: https://goo.gl/gFlAcb
Kannus P, Paavola M, Paakkala T, Parkkari J, Järvinen T, et al. Pathophysiology of overuse tendon injury. Radiologe. 2002; 42: 766-770. Ref.: https://goo.gl/O8lb2p
Leppilahti J, Orava S. Total Achilles tendon rupture: a review. Sports Med. 1998; 25: 79-100. Ref.: https://goo.gl/uwWXJ2
Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med. 1976; 1: 145-50. Ref.: https://goo.gl/GdtDrJ
Maffulli N, Oliva F, Costa V, Del Buono A. The management of chronic rupture of the Achilles tendon: minimally invasive peroneus brevis tendon transfer. Bone Joint J. 2015; 97: 353-357. Ref.: https://goo.gl/UzRTvD
Pintore E, Barra V, Pintore R, Maffulli N. Peroneus brevis tendon transfers in neglected tears of Achilles tendon. J Trauma Injury. 2001; 50: 71-78. Ref.: https://goo.gl/Kpm3Ch
Padanilam T. Chronic Achilles tendon ruptures. Foot Ankle Clin. 2009; 14: 711-728. Ref.: https://goo.gl/vxu9vo
Distefano VJ, Nixon JE. Achilles tendon rupture: pathogenesis, diagnosis, and treatment by a modified pullout wire technique. J Trauma. 1972; 12: 671-677. Ref.: https://goo.gl/txgXfe
Hartog BD. Insertional Achilles tendinosis: pathogenesis and treatment. Foot Ankle Clin. 2009; 14: 639-650. Ref.: https://goo.gl/VDrMZO
Miskulin M, Miskulin A, Klobucar H, Kuvalja S. Neglected rupture of the Achilles tendon treated with peroneus brevis transfer: a functional assessment of 5 cases. J Foot Ankle Surg. 2005; 44: 49-56. Ref.: https://goo.gl/zqHdjU
Movin T, Ryberg A, McBride DJ, Maffulli N. Acute rupture of Achilles tendon. Foot Ankle Clin. 2005; 10: 331-356. Ref.: https://goo.gl/RP0BCk
Tan G, Sabb B, Kadakia AR. Non-surgical management of Achilles ruptures. Foot Ankle Clin. 2009; 14: 675-684. Ref.: https://goo.gl/p5yRJw
Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957; 179: 56-58. Ref.: https://goo.gl/hZpsye
Matles AL. Rupture of the tendo Achilles. Another diagnostic sign. Bull Hosp Joint Dis. 1975; 36: 48-51. Ref.: https://goo.gl/XqBaQv
O’Brien T. The needle test for complete rupture of the Achilles tendon. J Bone Joint Surg Am. 1975;36:48-51
Copeland SA. Rupture of the Achilles tendon: a new clinical test. Ann R Coll Surg Engl. 1990; 72: 270-271. Ref.: https://goo.gl/jUqj0g
Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998; 26: 266-270. Ref.: https://goo.gl/vyACIj
Arner O, Lindholm A, Orell SR. Histologic changes in subcutaneous rupture of the Achilles tendon; a study of 74 cases. Acta Chir Scand. 1959; 116: 484-490. Ref.: https://goo.gl/dh6E1p
Turco VJ, Spinella AJ. Achilles rendon ruptures-peroneus brevis transfer. Foot Ankle. 1987; 7: 253-259. Ref.: https://goo.gl/I2D4Fd
Popovic N, Lemaire R. Diagnosis and treatment of acute ruptures of the Achilles tendon. Current concepts review. Acta Orthop Belg. 1999; 65: 458-471. Ref.: https://goo.gl/Pfo0Hg
Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N. Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med. 2002; 12: 273-278. Ref.: https://goo.gl/AiNLC6
Rolf C, Movin T. Etiology, histopathology, and outcome of surgery in achillodynia. Foot Ankle Int. 1997; 18: 565-569. Ref.: https://goo.gl/xxbkav
Maffulli N, Dyamond NP, Capasso G. Ultrasonographic findings in subcutaneous rupture of Achilles tendon. J Sports Med Phys Fitness. 1989; 29: 365-368. Ref.: https://goo.gl/ZwI0Qr
Fornage BD. Achilles tendon: US examination. Radiology. 1986; 159: 759-764. Ref.: https://goo.gl/voMiHi
Barbolini G, Monetti G, Montorsi A, Grandi M, et al. Results with high-definition sonography in the evaluation of Achilles tendon conditions. Int J Sports Traumatol. 1988; 10: 225-234.
Maffulli N, Dyamond NP, Regine R. Surgical repair of ruptured Achilles tendon in sportsmen and sedentary patients: a longitudinal ultrasound assessment. Int J Sports Med. 1990; 11: 78-84. Ref.: https://goo.gl/ETPGcL
Leslie H, Edwards W. Neglected ruptures of the Achilles tendon. Foot Ankle Clin. 2005; 10: 357-370. Ref.: https://goo.gl/aUzArO
Bleakney RR, White LM. Imaging of the Achilles tendon. Foot Ankle Clin. 2005; 10: 239-254. Ref.: https://goo.gl/4GXZJN
Hartgerink P, Fessell DP, Jacobson JA, van Holsbeeck MT. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 2001; 220: 401-412. Ref.: https://goo.gl/KsMpHR
Kabbani YM, Mayer DP. Magnetic resonance imaging of tendon pathology about the foot and ankle. Part I. Achilles tendon. J Am Podiatr Med Assoc. 1993; 83: 418-420. Ref.: https://goo.gl/9zJh2p
Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, et al. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorder? A two years prospective study. Br J Sports Med. 2003; 37: 149-153. Ref.: https://goo.gl/drj18T
Clement Db, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. 1984; 12: 179-184. Ref.: https://goo.gl/EAcaIC
Schweitzer ME, Marasick D. MR imaging of disorders of the Achilles tendon. Am J Roentgenol. 2000; 175: 613-625. Ref.: https://goo.gl/BhMn3A
Khan RJK, Fick D, Brammar TJ, Crawford J, Parker MJ. Surgical interventions for treating acute Achilles tendon ruptures (review). The Cochrane Collaboration: John Wiley and sons, 2008.
Wallace RGH, Heyes GJ, Michael ALR. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of rerupture. J Bone Joint Surg Br. 2011; 93: 1362-1366. Ref.: https://goo.gl/kciE87
Seth Rosenzweig, MD, Frederick M. Azar, MD. Open repair of acute achilles tendon ruptures. Foot Ankle Clin N Am. 2009; 699-709. Ref.: https://goo.gl/xpjjPK
The Strength of Achilles Tendon Repair: An In Vitro Study of the Biomechanical Behavior in Human Cadaver Tendons, n.d. ResearchGate.
Buchgraber A, Pässler HH. Percutaneous repair of Achilles tendon rupture: immobilization versus functional postoperative treatment. Clin Orthop Relat Res. 1997; 341: 113-122. Ref.: https://goo.gl/75EQdc
Kakiuchi M. A combined open and percutaneous technique for repair of Tendo Achillis: comparison with open repair. J Bone Joint Surg Br. 1995; 77: 60-63. Ref.: https://goo.gl/xPbU0r
Fernendez-Fairen M, Gimeno C. Augmented repair of Achilles tendon ruptures. Am J Sports Med 1997; 25: 177-1781. Ref.: https://goo.gl/JKH8rd
Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new techinque. Clin Orthop Relat Res. 1977; 128: 247-255. Ref.: https://goo.gl/sVxPtR
KleinW, Lang DM, Saleh M. The of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov. 1991; 76: 223-228. Ref.: https://goo.gl/NuRjRv
Makulavicius A, Martin Oliva X, Mazarevicius G, Klinga M, Uvarovas V, et al. Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury. Folia Morphol (Warsz). 2016; 75: 53-59. Ref.: https://goo.gl/NBnwNq
Amlang MH, Zwipp H, Friedrich A, Peaden A, Bunk A, et al. Ultrasonographic classification of achilles tendon ruptures as a rationale for individual treatment selection. ISRN Orthop. 2011; 869703. Ref.: https://goo.gl/4L9Bm3
Carmont MR, Rossi R, Scheffler S, Mei-Dan O, Beaufils P. Percutaneous &Mini Invasive Achilles tendon repairs. Sports Med Arthrosc Rehabil Ther Technol. 2011; 3: 28. Ref.: https://goo.gl/vFqA9o
Muezzinoglu S, Memisoglu K, Sarman H, Aydin A, Atmaca H. Internal splinting: a new technique for Achilles tendon repair. Techn Foot Ankle Surg. 2013; 12: 92-98. Ref.: https://goo.gl/avm4FJ
Sarman H, Muezzinoglu US, Memisoglu K, Aydin A, Atmaca H, et al. Comparison of Semi-Invasive “Internal Splinting” and Open Suturing Techniques in Achilles Tendon Rupture Surgery. J Foot Ankle Surg. 2016; 55: 965-970. Ref.: https://goo.gl/Z7nDve
Mortensen HM, Skov O, Jensen PE. Early motion of the ankle after operative treatment of a rupture of the achilles tendon. A prospective randimized clinical and radiographic study. J Bone Joint Surg Am. 1999; 81: 983-990. Ref.: https://goo.gl/ze44mC
Kearney RS, Costa ML. Current concept in the rehabilitation of an acute rupture of the tendo Achillis. J Bone Joint Surg Br. 2012; 94: 28-31. Ref.: https://goo.gl/itLDVe
Kearney RS, Mc Guinness K, Achten J, Costa ML. A systemati review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherapy. 2012; 98: 24-32. Ref.: https://goo.gl/Dl9L8j
Lin TW, Cardenas L, Soslowsky LJ. Biomechanics of tendon injury and repair. J Biomech. 2004; 37: 867-877. Ref.: https://goo.gl/9cKKEZ
Costa ML, MacMillan K, Halliday D, Chester R, Shepstone L, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg Br. 2006; 88: 69-77. Ref.: https://goo.gl/3XH2pm
Calder JDF, Saxby TS. Early, active rehabilitation following mini-open repair of Achilles tendon rupture: a prospective study. Br J Sport Med. 2005; 39: 857-859. Ref.: https://goo.gl/mEUmC0
Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degree of plantarflexion. Foot Ankle Int. 2001; 22: 572-574. Ref.: https://goo.gl/dNRpIY
Kangas J, Pajala A, Siira P, Hämäläinen M, Leppilahti J. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospetive, randomized clinical study. J Trauma. 2003; 54: 1171-1180. Ref.: https://goo.gl/ZglosG
Kearney S, McGuinness KR, Achten J, Costa ML. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherpy. 2012; 98: 24-32. Ref.: https://goo.gl/7ySKwm
Carden DG, Noble J, Chalmers J, Lunn P, Ellis J. Rupture of the calcaneal tendon. The early and late management. J Bone Joint Surg Br. 1987; 69: 416-420. Ref.: https://goo.gl/rUHs70
Saleh M, Marshall PD, Senior R, MacFarlane A. The Sheffield splint for controlled early mobilization after rupture of the calcaneal tendon. A prospective, randomized comparison with plaster treatment. J Bone Joint Surg Br. 1992; 740: 206-209. Ref.: https://goo.gl/8V4SZd
Moller M, Movin T, Granhed H, Lind K, Faxén E, et al. Acute rupture of tendon Achilles: A prospective randomized study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br. 2001; 83: 843-848. Ref.: https://goo.gl/MZmPIW
Weber M, Niemann M, Lanz R, Müller T. Non-operative treatment of acute rupture of the Achilles tendon: results of a new protocol and comparison with operative treatment. Am J Sports Med. 2003; 31: 685-691. Ref.: https://goo.gl/2Rgt3E
Wong J, Barras V, Maffulli N. Quantitative review of operative and non-operative management of Achilles tendon ruptures. Am J Sports Med. 2002; 30: 565-575. Ref.: https://goo.gl/cIKf5D
Lea RB, Smith L. Non surgical treatment of tendo Achillis rupture. J Bone Joint Surg Am. 1972; 54: 1398-1407. Ref.: https://goo.gl/MyzQ3Q
Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br. 2011; 93: 1362-1366. Ref.: https://goo.gl/vbGG16
Hufner T, Gaulke R, Imrecke J, Krettek C, Stubig T. Conservative functional treatment of Achilles tendon rupture. Unfallchirurg. 2010; 113: 699-702. Ref.: https://goo.gl/en5oyp
Spek M, Klaue K. Early full weight-bearing and functional treatment after surgical repair of acute Achilles tendon rupture. Am J Sports Med. 1998; 26: 789-793. Ref.: https://goo.gl/uhkMKd
Bhattacharyya M, Gerber B. Mini-invasive surgical repair of the Achilles tendon: does it reduce post-operative morbidity? Int Orthop. 2009; 33: 151-156. Ref.: https://goo.gl/UeJsJP
Jacob KM, Paterson R. Surgical repair followed by functional rehabilitation for acute and chronic Achilles tendon injuries: excellent functional results, patient satisfaction and no reruptures. ANZ J Surg. 2007; 77: 287-291. Ref.: https://goo.gl/qgnxbF
No authors listed. Medical RESEARCH Council: Complex interventions guidance, 2008. http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871 (date last accessed 4 August 2011).