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Jun-Beom Kim
, Ja-Yeong Yoon
, Ja-Yeong Yoon
Abstract
Achilles tendon rupture is a common sports injury encountered in younger populations. Various treatment methods are used for acute and chronic rupture. Several treatments for each condition are available, each having their advantages and disadvantages. In an acute rupture, surgical treatment may be a priority for younger patients or those wishing a quick return to play, but the long-term functional outcome is similar to non-surgical treatment. In addition, the re-rupture rate shows a slight difference between the two treatments. The clinical outcomes are similar regardless of the surgical treatment, but an accelerated rehabilitation program should be accompanied by good results. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment. Treatments are chosen based on the size of the tendon defect. This article reviews the current updates in the treatment of Achilles tendon rupture that will help clinicians choose the appropriate treatment.
Figures and Tables
Figure 1
The technique of casting for nonsurgical treatment of Achilles tendon rupture. With the patient sitting, the below-knee cast is placed with the foot in gravity equinus.
Figure 2
(A) Various suture techniques for repair of ruptured Achilles tendon. Double-suture Bunnell technique. (B) Single-suture Bunnell technique. (C) Double-suture Kessler technique. (D) Single-suture Kessler technique. (E) Double-suture Krackow technique. Data from Clanton et al. (In: Coughlin M, Saltzman C, Anderson RB, editors. Mann's surgery of the foot and ankle. 9th ed. Philadelphia: Saunders Elsevier; 2014. p.1625-40).19)
Figure 3
Schematic configurations of the repair. (A) Percutaneous repair of Achilles tendon. (B) Percutaneous repair of Achilles tendon. (C) Percutaneous repair of Achilles tendon. (D) Preparation of the patient for the repair. (E) Postoperative gross photo in the intraoperative field. Data from the article of Guillo et al. (Surgeon. 2013;11:14-9).21)
Figure 4
Direct end-to-end repair. (A) Debridement of chronic ruptured Achilles tendon. (B) Sutures are placed between proximal and distal stump of tendon.
Figure 5
V-Y tendon advancement or lengthening technique. (A) Debridement of the chronic ruptured Achilles tendon. (B) Obvious defect in Achilles tendon following resection of a nonviable area is measured. (C) Closure of Bunnell sutures, and the proximal segment was sutured by Y-shape.
Figure 6
Single turn-down flap technique. (A) Obvious defect in Achilles tendon following resection of a nonviable area. (B) Turn-down flap is marked in midportion of Achilles. (C) Sutures are placed in distal stump of tendon.
Figure 7
(A) Flexor hallucis longus (FHL) tendon transfer technique. FHL harvested in distal aspect of incision near fibro-osseous tunnel. (B) FHL tendon is secured with a pull-out suture and passed through a drill hole in calcaneus.
Table 1
Treatment of Chronic Achilles Tendon Rupture, Based on the Defect Size
FHL: flexor hallucis longus.
Data from the article of Steginsky et al. (Foot Ankle Clin. 2017;22: 715-34).9)
Table 2
Comparison of Tendons for Tendon Transfer in Treatment of Chronic Achilles Tendon Rupture
GSC: Gastrocnemius-soleus.
Data from Azar (In: Azar FM, Canale ST, Beaty JH, editors. Campbell's operative orthopaedics. 13th ed. Philadelphia: Elsevier; 2013. p. 2405-56).37)
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