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World J Orthop. May 18, 2015; 6(4): 380-386
Published online May 18, 2015. doi: 10.5312/wjo.v6.i4.380
Management of achilles tendon injury: A current concepts systematic review
Vivek Gulati, Matthew Jaggard, Shafic Said Al-Nammari, Chika Uzoigwe, Pooja Gulati, Nizar Ismail, Charles Gibbons, Chinmay Gupte
Vivek Gulati, Matthew Jaggard, Shafic Said Al-Nammari, Chika Uzoigwe, Pooja Gulati, Nizar Ismail, Charles Gibbons, Department of Orthopaedic Surgery, Chelsea and Westminster Hospital, London SW10 9NJ, United Kingdom
Chinmay Gupte, Academic Department of Orthopaedic Surgery, Charing Cross Hospital, London W6 8RF, United Kingdom
Author contributions: Gulati V, Jaggard M and Uzoigwe C were involved in the writing of the manuscript; Gulati V, Al-Nammari SS, Gulati P and Ismail N performed the literature search and collated the material; Gibbons C and Gupte C reviewed the manuscript, formed its structure and supplied editorial input.
Conflict-of-interest: The authors declare that are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vivek Gulati, Specialist Registrar, Department of Orthopaedic Surgery, Chelsea and Westminster Hospital, 369 fulham road, London SW10 9NJ, United Kingdom. vivek0@hotmail.com
Telephone: +44-7803-902595
Received: September 4, 2014
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
Processing time: 259 Days and 12.4 Hours
Abstract

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.

Keywords: Orthopaedic surgery; Achilles tendon injury; Sports injury; Tendon rupture; Conservative management

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.