Published online May 18, 2015. doi: 10.5312/wjo.v6.i4.380
Peer-review started: September 4, 2014
First decision: January 20, 2015
Revised: March 28, 2015
Accepted: April 16, 2015
Article in press: April 18, 2015
Published online: May 18, 2015
Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.
Core tip: Achilles tendon rupture is a common injury. Simmonds or Thomas’ test is a reliable diagnostic tool with a sensitivity of between 0.89-0.93. Studies have not shown conclusive superiority of operative repair compared with non-operative and casting techniques. Non-operative management has a more favourable complication profile. There is emerging evidence that the traditional perception that non-operative management is associated with higher re-rupture rates no longer holds true for the new management strategies which assess tendon gap and use a dedicated “Achilles tendon management infrastructure”. It is important that clinicians can recognize the injury and delayed diagnosis can lead to significant morbidity.