Current Update in Achilles Tendon Rupture Management: Operative or Nonoperative?
DOI:
https://doi.org/10.31282/joti.v7n2.132Keywords:
Achilles Tendon Rupture, Surgical Treatment, Conservative TreatmentAbstract
The Achilles tendon is the most commonly ruptured tendon in the foot and ankle region. The peak incidence of Achilles tendon rupture occurs in the age range of 30-49 years, with a higher prevalence among males. Various risk factors, including aging, obesity, episodic athletic activity, engagement in high-impact sports, antibiotic use, and systemic factors, contribute to the occurrence of Achilles tendon rupture. Beyond the injury mechanism, it is crucial to assess any history of minor or repetitive trauma to the Achilles tendon and identify associated risk factors. Thorough examination and comparison of both the affected and unaffected sides are essential. While the diagnosis of Achilles Tendon Rupture is primarily clinical, radiological imaging can aid in visualizing the tendon gap. Treatment options for Achilles tendon rupture include conservative and surgical approaches. Despite a lower re-rupture rate associated with surgical treatment, recent evidence suggests that conservative treatment provides comparable results. However, return to activity was found to be better in surgical treatment with early rehabilitation
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Teoh KH, Tanaka H, Hariharan K. Management of acute Achilles tendon rupture. Orthop Trauma. 2018 Dec;32(6):401–7.
Mansfield K, Dopke K, Koroneos Z, Bonaddio V, Adeyemo A, Aynardi M. Achilles Tendon Ruptures and Repair in Athletes—a Review of Sports-Related Achilles Injuries and Return to Play. Curr Rev Musculoskelet Med. 2022 Jul 9;15(5):353–61.
Meulenkamp B, Stacey D, Fergusson D, Hutton B, Mlis RS, Graham ID. Protocol for treatment of Achilles tendon ruptures; a systematic review with network meta-analysis. Syst Rev. 2018 Dec;7(1):247.
Lantto I, Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J. Epidemiology of Achilles tendon ruptures: Increasing incidence over a 33‐year period. Scand J Med Sci Sports [Internet]. 2015 Feb [cited 2024 Jan 18];25(1). Available from: https://onlinelibrary.wiley.com/doi/10.1111/sms.12253
Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020;12(1):1.
Ochen Y, Beks RB, Van Heijl M, Hietbrink F, Leenen LPH, Van Der Velde D, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019 Jan 7;k5120.
Mahan J, Damodar D, Trapana E, Barnhill S, Nuno AU, Smyth NA, et al. Achilles tendon complex: The anatomy of its insertional footprint on the calcaneus and clinical implications. J Orthop. 2020 Jan;17:221–7.
Park JW, Lee SJ, Choo HJ, Kim SK, Gwak HC, Lee SM. Ultrasonography of the ankle joint. Ultrasonography. 2017 Oct 1;36(4):321–35.
Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current Concepts Review Update: Insertional Achilles Tendinopathy. Foot Ankle Int. 2017 Oct;38(10):1160–9.
Giacobazzi M, Hansen M, Gologram M, Mitchell R, Kasik C, Gritsiuta AI. Primary repair of complete Achilles tear augmented with amnion allograft wrap in college basketball player with a history of contralateral Achilles rupture: a case report. AME Case Rep. 2023 Oct;7:36–36.
Khayyeri H, Blomgran P, Hammerman M, Turunen MJ, Löwgren A, Guizar-Sicairos M, et al. Achilles tendon compositional and structural properties are altered after unloading by botox. Sci Rep. 2017 Oct 12;7(1):13067.
Müller SA, Evans CH, Heisterbach PE, Majewski M. The Role of the Paratenon in Achilles Tendon Healing: A Study in Rats. Am J Sports Med. 2018 Apr;46(5):1214–9.
d’Hooghe P, Nilsson-Helander K, Olsson N, Karlsson J. Total Achilles Tendon Ruptures: Current Trends. In: Doral MN, Karlsson J, editors. Sports Injuries [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015 [cited 2024 Jan 19]. p. 2321–34. Available from: https://link.springer.com/10.1007/978-3-642-36569-0_185
Manent A, López L, Coromina H, Santamaría A, Domínguez A, Llorens N, et al. Acute Achilles Tendon Ruptures: Efficacy of Conservative and Surgical (Percutaneous, Open) Treatment—A Randomized, Controlled, Clinical Trial. J Foot Ankle Surg. 2019 Nov;58(6):1229–34.
Varshney MK. Essential Orthopedics: Principles and Practice (2 Volumes) [Internet]. Jaypee Brothers Medical Publishers (P) Ltd.; 2016 [cited 2024 Jan 18]. Available from: https://www.jaypeedigital.com/book/9789352501755
Leino O, Keskinen H, Laaksonen I, Mäkelä K, Löyttyniemi E, Ekman E. Incidence and Treatment Trends of Achilles Tendon Ruptures in Finland: A Nationwide Study. Orthop J Sports Med. 2022 Nov 1;10(11):232596712211315.
Raikin SM, Garras DN, Krapchev PV. Achilles Tendon Injuries in a United States Population. Foot Ankle Int. 2013 Apr;34(4):475–80.
Lui PPY, Wong CM. Biology of Tendon Stem Cells and Tendon in Aging. Front Genet. 2020 Jan 16;10:1338.
Kwan KYC, Ng KWK, Rao Y, Zhu C, Qi S, Tuan RS, et al. Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches. Int J Mol Sci. 2023 Oct 14;24(20):15183.
Macchi M, Spezia M, Elli S, Schiaffini G, Chisari E. Obesity Increases the Risk of Tendinopathy, Tendon Tear and Rupture, and Postoperative Complications: A Systematic Review of Clinical Studies. Clin Orthop. 2020 Aug;478(8):1839–47.
Lui PPY, Yung PSH. Inflammatory mechanisms linking obesity and tendinopathy. J Orthop Transl. 2021 Nov;31:80–90.
Čretnik A, Košir R. Incidence of Achilles tendon rupture: 25-year regional analysis with a focus on bilateral ruptures. J Int Med Res. 2023 Nov;51(11):03000605231205179.
Lewis T, Cook J. Fluoroquinolones and Tendinopathy: A Guide for Athletes and Sports Clinicians and a Systematic Review of the Literature. J Athl Train. 2014 Jun 1;49(3):422–7.
Tarantino D, Palermi S, Sirico F, Corrado B. Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. J Funct Morphol Kinesiol. 2020 Dec 17;5(4):95.
Boyd RP, Dimock R, Solan MC, Porter E. Achilles tendon rupture: how to avoid missing the diagnosis. Br J Gen Pract. 2015 Dec;65(641):668–9.
Periasamy M, Venkatramani H, Shanmuganathan RS. Management of Chronic Achilles Tendon Injuries—Review of Current Protocols and Surgical Options. Indian J Plast Surg. 2019 Jan;52(01):109–16.
De La Fuente C, Cruz-Montencinos C, La Fuente CD, Y Lillo RP, Chamorro C, Henriquez H. Early Short-Term Recovery of Single-Leg Heel Rise and ATRS After Achilles Tenorrhaphy: Cluster Analysis. Asian J Sports Med [Internet]. 2018 Mar 10 [cited 2024 Jan 18];9(1). Available from: https://brieflands.com/articles/asjsm-67661.html
Porter GM, Haupt ET, Kaplan JR, Charlton TP. The STAMP Test: A Novel Clinical Test in Diagnosing Achilles Tendon Ruptures. Foot Ankle Orthop. 2022 Jan;7(1):2473011421S0040.
Pass B, Robinson P, Ha A, Levine B, Yablon CM, Rowbotham E. The Achilles Tendon: Imaging Diagnoses and Image-Guided Interventions - AJR Expert Panel Narrative Review. Am J Roentgenol. 2022 Sep;219(3):355–68.
Kadakia AR, Dekker RG, Ho BS. Acute Achilles Tendon Ruptures: An Update on Treatment. J Am Acad Orthop Surg. 2017 Jan;25(1):23–31.
Moore ML, Pollock JR, Karsen PJ, Haglin JM, Lai CH, Elahi MA, et al. Open Achilles Tendon Repair. JBJS Essent Surg Tech. 2023;13(1):e21.00054.
Martin KD, Crouser NJ, Khan IA. Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS). JBJS Essent Surg Tech. 2022;12(3):e21.00050.
Caolo KC, Eble SK, Rider C, Elliott AJ, Demetracopoulos CA, Deland JT, et al. Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair. Foot Ankle Orthop. 2021 Oct;6(4):247301142110600.
Seow D, Islam W, Randall GW, Azam MT, Duenes ML, Hui J, et al. Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3528–40.
Reda Y, Farouk A, Abdelmonem I, El Shazly OA. Surgical versus non-surgical treatment for acute Achilles’ tendon rupture. A systematic review of literature and meta-analysis. Foot Ankle Surg. 2020 Apr;26(3):280–8.
She G, Teng Q, Li J, Zheng X, Chen L, Hou H. Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs. Front Surg. 2021 Feb 18;8:607743.
Johns W, Walley KC, Seedat R, Thordarson DB, Jackson B, Gonzalez T. Career Outlook and Performance of Professional Athletes After Achilles Tendon Rupture: A Systematic Review. Foot Ankle Int. 2021 Apr;42(4):495–509.
Jónsdóttir US, Brorsson A, Nilsson Helander K, Tranberg R, Larsson MEH. Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis. Orthop J Sports Med. 2023 Feb 1;11(2):232596712211451.
Cohen D, Sandman E, Saran N, Petrisor B, Bhandari M, Veljkovic A, et al. Evidence-based treatment of Achilles tendon rupture. Can J Surg. 2023 Jul 4;66(4):E356–7.
Jildeh TR, Eller EB. Achilles tendon rupture treatment: Operative versus nonoper ersus nonoperative. Tech Foot Ankle Surg. 2021;20(2):82-85.
Young SW, Patel A, Zhu M, Van Dijck S, McNair P, Bevan WP, et al. Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Randomized Controlled Trial. J Bone Jt Surg. 2014 Jul 2;96(13):1073–9.
Morimoto S, Iseki T, Nakayama H, Shimomura K, Nishikawa T, Nakamura N, et al. Return to the original sport at only 3 months after an Achilles tendon rupture by a combination of intra-tissue injection of freeze-dried platelet-derived factor concentrate and excessively early rehabilitation after operative treatment in a male basketball player: A case report. Regen Ther. 2021 Dec;18:112–6.
