Treatment of Tendon Rupture
For acute Achilles tendon rupture, early protected weight bearing (≤2 weeks) with a device that limits dorsiflexion is recommended following either surgical or non-surgical treatment to achieve optimal outcomes. 1, 2
Diagnostic Confirmation
- Diagnosis should be confirmed using at least two of the following: Thompson/Simonds squeeze test, decreased ankle plantar flexion strength, presence of a palpable gap, and increased passive ankle dorsiflexion 3
- Advanced imaging (ultrasound or MRI) is not routinely necessary when clinical diagnosis is clear but can be used for confirmation in uncertain cases 3
- Initial immobilization in maximum plantar flexion using a fixed-ankle walker-type device is recommended while awaiting definitive treatment 4
Treatment Options
Surgical Treatment
- Surgical repair is associated with lower re-rupture rates but higher complication rates, including infection and wound problems 4, 5
- Three surgical approaches are available:
- Open repair: Higher rates of wound complications and infection 2
- Limited open repair: Allows patients to return to normal walking, stair climbing, and sports in significantly less time than standard open repair 2
- Percutaneous repair: Results in significantly less wound breakdown/delay of healing and fewer scar adhesions; patients score significantly higher on physical and mental component scores compared to open repair 2, 6
- Minimally invasive techniques combined with accelerated functional rehabilitation offer the best results in treating Achilles tendon ruptures 6
Non-Surgical Treatment
- Non-surgical treatment has higher re-rupture rates but fewer overall complications 4, 5
- Preferred for nursing home patients and those with lower functional demands due to similar functional outcomes when combined with proper rehabilitation 3
Post-Treatment Management
Early Rehabilitation Protocol
- Begin protected weight bearing within 2 weeks following treatment (surgical or non-surgical) 1, 2, 3
- Use a protective device that limits dorsiflexion to prevent compromise of the repair 1, 2
- Begin mobilization by 2-4 weeks using a protective device 1, 2, 3
- Early weight bearing allows quicker return to activities during the first 6 months compared to traditional non-weight bearing protocols 1, 2
- By 12 months, outcomes such as pain and function are similar regardless of early or delayed weight bearing protocols 1, 2
Potential Complications to Monitor
- Rerupture: Higher risk with non-operative treatment and with non-compliance to rehabilitation protocols 1, 5
- Wound complications: Higher risk with open surgical repair 2, 5
- Sural nerve injuries: Can occur with both percutaneous and open techniques 2
- Deep vein thrombosis: Requires monitoring regardless of treatment approach 2, 3
Important Considerations
- Patient compliance with the prescribed protocol is crucial to prevent rerupture 1, 2, 3
- One study found a significantly higher rerupture rate in early postoperative weight-bearing patients who were non-compliant with their splint use 1
- The combination of minimally invasive surgical repair and accelerated functional rehabilitation appears to offer the best balance between minimizing rerupture risk and avoiding wound complications 6