From the Research
Management of Incomplete Achilles Tendon Rupture
The management of an incomplete Achilles tendon rupture can be approached through both conservative and surgical methods.
- Conservative management options include physical therapy, bracing, and custom ankle-foot orthoses 1.
- Surgical options depend on the quality of the existing tendon, size of the defect, and the surgeon's comfort with the technique, and may include primary repair, V-Y tendon advancement, turndown flap, tendon transfers, and other allografts 1.
- The choice between conservative and surgical treatment may be based on factors such as the severity of the rupture, patient age, and activity level 2.
- A systematic review with network meta-analysis has been planned to synthesize the evidence on management options for acute Achilles tendon rupture and identify which treatment gives the best functional outcomes 3.
Treatment Considerations
- The "50% rule" for surgical treatment of partial ruptures, which suggests that ruptures affecting less than 50% of the tendon's width can be treated conservatively, may need to be reconsidered based on new evidence suggesting that partial ruptures may progress to complete ruptures under loading conditions elicited from functional rehabilitation protocols, even for partial ruptures affecting less than 50% of the tendon's width 4.
- Early muscle contraction exercises without joint motion may promote tendon healing and prevent calf muscle atrophy after Achilles tendon rupture and surgical repair, while early static stretching may not contribute to tendon healing and may induce calf muscle atrophy 5.
- A dedicated management programme, such as the Swansea Morriston Achilles Rupture Treatment (SMART) programme, which includes a comprehensive management protocol with a dedicated Achilles clinic, ultrasound examination, functional orthoses, early weight-bearing, and an accelerated exercise regime, may result in a low rate of re-rupture, satisfactory outcome, and reduced healthcare costs 2.