J Korean Foot Ankle Soc.  2021 Jun;25(2):72-75. 10.14193/jkfas.2021.25.2.72.

Nonoperative Treatment of Acute Achilles Tendon Rupture

• Sung KS
• Won JY

• KMID: 2516643
• DOI: http://doi.org/10.14193/jkfas.2021.25.2.72

Abstract

The incidence of Achilles tendon rupture is increasing as more people participate in sports and physical activities. However, whether to treat a complete rupture of the Achilles tendon, conservatively or operatively, is still controversial. Current studies show that the nonoperative treatment of acute Achilles tendon rupture with short-term immobilization for up to two weeks and subsequent accelerated functional rehabilitation with protected weight-bearing results in similar functional outcomes and re-rupture rates compared to those treated surgically. Also, nonoperative treatment does not risk any surgical morbidity such as wound problems, infection, and nerve injury. Therefore, the treatment options for acute Achilles tendon rupture should be carefully chosen in consultation with patients regarding possible clinical outcomes and complications of both treatment options.

Keyword

Achilles tendon; Rupture; Nonoperative treatment

Figure

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  Fig. 1 The rate of surgical repair of acute Achilles tendon rupture. Data from the article of Sheth et al. (Bone Joint J. 2017;99-B:1629-36).23) AAOS: American Academy of Orthopaedic Surgeons, AATR: acute Achilles tendon rupture.

Reference

1. Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. 1999; Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 9:157–60. doi: 10.1097/00042752-199907000-00007. DOI: 10.1097/00042752-199907000-00007. PMID: 10512344.

2. Möller A, Astron M, Westlin N. 1996; Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 67:479–81. doi: 10.3109/17453679608996672. DOI: 10.3109/17453679608996672. PMID: 8948254.

3. Maffulli N. 1999; Rupture of the Achilles tendon. J Bone Joint Surg Am. 81:1019–36. doi: 10.2106/00004623-199907000-00017. DOI: 10.2106/00004623-199907000-00017. PMID: 10428136.

4. Maffulli N, Ewen SW, Waterston SW, Reaper J, Barrass V. 2000; Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons. An in vitro model of human tendon healing. Am J Sports Med. 28:499–505. doi: 10.1177/03635465000280040901. DOI: 10.1177/03635465000280040901. PMID: 10921640.

5. Järvinen M, Józsa L, Kannus P, Järvinen TL, Kvist M, Leadbetter W. 1997; Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports. 7:86–95. doi: 10.1111/j.1600-0838.1997.tb00124.x. DOI: 10.1111/j.1600-0838.1997.tb00124.x. PMID: 9211609.

6. Newnham DM, Douglas JG, Legge JS, Friend JA. 1991; Achilles tendon rupture: an underrated complication of corticosteroid treatment. Thorax. 46:853–4. doi: 10.1136/thx.46.11.853. DOI: 10.1136/thx.46.11.853. PMID: 1771608. PMCID: PMC1021044.

7. Poon CC, Sundaram NA. 1997; Spontaneous bilateral Achilles tendon rupture associated with ciprofloxacin. Med J Aust. 166:665. doi: 10.5694/j.1326-5377.1997.tb123308.x. DOI: 10.5694/j.1326-5377.1997.tb123308.x. PMID: 9216589.

8. McGarvey WC, Singh D, Trevino SG. 1996; Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a case report and literature review. Foot Ankle Int. 17:496–8. doi: 10.1177/107110079601700811. DOI: 10.1177/107110079601700811. PMID: 8863030.

9. Donck JB, Segaert MF, Vanrenterghem YF. 1994; Fluoroquinolones and Achilles tendinopathy in renal transplant recipients. Transplantation. 58:736–7. DOI: 10.1097/00007890-199409000-00021. PMID: 7940700.

10. Pajala A, Kangas J, Siira P, Ohtonen P, Leppilahti J. 2009; Augmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am. 91:1092–100. doi: 10.2106/JBJS.G.01089. DOI: 10.2106/JBJS.G.01089. PMID: 19411457.

11. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. 2005; Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 87:2202–10. doi: 10.2106/JBJS.D.03049. DOI: 10.2106/JBJS.D.03049. PMID: 16203884.

12. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, et al. 2010; Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 38:2186–93. doi: 10.1177/0363546510376052. DOI: 10.1177/0363546510376052. PMID: 20802094.

13. McComis GP, Nawoczenski DA, DeHaven KE. 1997; Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg Am. 79:1799–808. doi: 10.2106/00004623-199712000-00005. DOI: 10.2106/00004623-199712000-00005. PMID: 9409793.

14. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, et al. 2010; Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 92:2767–75. doi: 10.2106/JBJS.I.01401. DOI: 10.2106/JBJS.I.01401. PMID: 21037028.

15. Keating JF, Will EM. 2011; Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Joint Surg Br. 93:1071–8. doi: 10.1302/0301-620X.93B8.25998. DOI: 10.1302/0301-620X.93B8.25998. PMID: 21768631.

16. Wallace RG, Heyes GJ, Michael AL. 2011; 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. 93:1362–6. doi: 10.1302/0301-620X.93B10.26187. DOI: 10.1302/0301-620X.93B10.26187. PMID: 21969435.

17. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. 2012; Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 94:2136–43. doi: 10.2106/JBJS.K.00917. DOI: 10.2106/JBJS.K.00917. PMID: 23224384. PMCID: PMC3509775.

18. Aujla R, Patel S, Jones A, Bhatia M. 2018; Predictors of functional outcome in non-operatively managed Achilles tendon ruptures. Foot Ankle Surg. 24:336–41. doi: 10.1016/j.fas.2017.03.007. DOI: 10.1016/j.fas.2017.03.007. PMID: 29409242.

19. Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Siira P, Laine V, et al. 2016; A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures. Am J Sports Med. 44:2406–14. doi: 10.1177/0363546516651060. DOI: 10.1177/0363546516651060. PMID: 27307495.

20. Eliasson P, Agergaard AS, Couppé C, Svensson R, Hoeffner R, Warming S, et al. 2018; The ruptured Achilles tendon elongates for 6 months after surgical repair regardless of early or late weightbearing in combination with ankle mobilization: a randomized clinical trial. Am J Sports Med. 46:2492–502. doi: 10.1177/0363546518781826. DOI: 10.1177/0363546518781826. PMID: 29965789.

21. Okoroha KR, Ussef N, Jildeh TR, Khalil LS, Hasan L, Bench C, et al. 2020; Comparison of tendon lengthening with traditional versus accelerated rehabilitation after Achilles tendon repair: a prospective randomized controlled trial. Am J Sports Med. 48:1720–6. doi: 10.1177/0363546520909389. DOI: 10.1177/0363546520909389. PMID: 32203675.

22. Brorsson A, Grävare Silbernagel K, Olsson N, Nilsson Helander K. 2018; Calf muscle performance deficits remain 7 years after an Achilles tendon rupture. Am J Sports Med. 46:470–7. doi: 10.1177/0363546517737055. DOI: 10.1177/0363546517737055. PMID: 29068725.

23. Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal S. 2017; Practice patterns in the care of acute Achilles tendon ruptures: is there an association with level I evidence? Bone Joint J. 99(B):1629–36. doi: 10.1302/0301-620X.99B12.BJJ-2017-0465.R1. DOI: 10.1302/0301-620X.99B12.BJJ-2017-0465.R1. PMID: 29212686.

24. Munegato D, Gridavilla G, Guerrasio S, Turati M, Cazzaniga C, Zanchi N, et al. 2018; Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation. Muscles Ligaments Tendons J. 7:554–61. doi: 10.11138/mltj/2017.7.3.554. DOI: 10.11138/mltj/2017.7.3.554. PMID: 29387651. PMCID: PMC5774931.