PROGRESS IN TREATMENT OF ACUTE Achilles TENDON RUPTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Nan , XIANG Dayong , YU Bin.

Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, 510515, P.R.China. Corresponding author: YU Bin, E-mail: yubinol@163.com;

Corresponding author：

Keywords：

Acute Achilles tendon ruptureNon-operative treatment; Open surgery; Percutaneous minimally invasive surgery

DOI：

10.7507/1002-1892.20130138

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Objective To review the progress in the treatment of acute Achilles tendon rupture. Methods Recent literature about the treatment of acute Achilles tendon rupture was reviewed and analyzed. Results Treatments of acute Achilles tendon rupture include operative and non-operative treatments. Operative treatments include open surgery and percutaneous minimally invasive surgery. Compared with non-operative treatment, operative treatment can effectively reduce the re-rupture incidence, but it had higher complication incidences of wound infection and nerve injury. Although early functional rehabilitation during non-operative treatment could reduce the re-rupture incidence, there is no consistent orthopaedic device and guideline for functional rehabilitation. Conclusion Both operative and non-operative treatments have advantages and disadvantages for the treatment of acute Achilles tendon rupture. No consistent conclusion is arrived regarding functional recovery. Future studies should explore the strategy of early functional rehabilitation during non-operative treatment and its mechanism of promoting tendon healing.

Citation： JIANG Nan,XIANG Dayong,YU Bin.. PROGRESS IN TREATMENT OF ACUTE Achilles TENDON RUPTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(5): 628-632. doi: 10.7507/1002-1892.20130138 Copy

1.	Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg, 2008, 97(3): 272-275.
2.	Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med, 1999, 9(3): 157-160.
3.	Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Joint Surg (Br), 2011, 93(8): 1071-1078.
4.	Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
5.	Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg (Am), 1981, 63(3): 394-399.
6.	Gwynne-Jones DP, Sims M, Handcock D. Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int, 2011, 32(4): 337-343.
7.	Suchak AA, Bostick G, Reid D, et al. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int, 2005, 26(11): 932-936.
8.	Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle, 1985, 6(1): 34-38.
9.	Maffulli N. Achilles tendon rupture. Br J Sports Med, 1995, 29(4): 279-280.
10.	Williams JG. Achilles tendon lesions in sport. Sports Med, 1993, 16(3): 216-220.
11.	McQuillan R, Gregan P. Tendon rupture as a complication of corticosteroid therapy. Palliat Med, 2005, 19(4): 352-353.
12.	Seeger JD, West WA, Fife D, et al. Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population. Pharmacoepidemiol Drug Sa, 2006, 15(11): 784-792.
13.	Wilson AM, Goodship AE. Exercise-induced hyperthermia as a possible mechanism for tendon degeneration. J Biomech, 1994, 27(7): 899-905.
14.	Birch HL, Wilson AM, Goodship AE. The effect of exercise-induced localised hyperthermia on tendon cell survival. J Exp Biol, 1997, 200(Pt 11): 1703-1708.
15.	Arner O, Lindholm A. Subcutaneous rupture of the Achilles tendon; a study of 92 cases. Acta Chir Scand Suppl, 1959, 116(Supp 239): 1-51.
16.	王亦璁. 骨与关节损伤. 北京: 人民卫生出版社, 2007: 1491.
17.	胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 3版. 北京: 人民军医出版社, 2005: 816.
18.	Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res, 1977, (128): 247-255.
19.	Gigante A, Moschini A, Verdenelli A, et al. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc, 2008, 16(2): 204-209.
20.	Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int, 2001, 22(7): 559-568.
21.	Henríquez H, Muñoz R, Carcuro G, et al. Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res, 2012, 470(4): 998-1003.
22.	Maffulli N, Longo UG, Ronga M, et al. Favorable outcome of percutaneous repair of achilles tendon ruptures in the elderly. Clin Orthop Relat Res, 2010, 468(4): 1039-1046.
23.	Chan AP, Chan YY, Fong DT, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3(1): 32.
24.	Majewski M, Rohrbach M, Czaja S, et al. Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med, 2006, 34(5): 793-798.
25.	Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med, 2005, 33(9): 1369-1379.
26.	McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg, 2011, 17(4): 211-217.
27.	Khan RJ, Fick D, Brammar TJ, et al. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2004, (3): CD003674.
28.	Möller M, Movin T, Granhed H, et al. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg (Br), 2001, 83(6): 843-848.
29.	Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg (Br), 2011, 93(10): 1362-1366.
30.	Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med, 2008, 36(9): 1688-1694.
31.	Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg (Am), 2010, 92(17): 2767-2775.
32.	Garrick JG. Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute achilles tendon ruptures? Clin J Sport Med, 2012, 22(4): 379-380.
33.	Karkhanis S, Mumtaz H, Kurdy N. Functional management of Achilles tendon rupture: A viable option for non-operative management. Foot Ankle Surg, 2010, 16(2): 81-86.
34.	Costa ML, Macmillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
35.	Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med, 2010, 38(11): 2186-2193.
36.	Bhandari M, Guyatt GH, Siddiqui F, et al. Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res, 2002, (400): 190-200.
37.	Khan RJ, Carey Smith R. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2010, (9): CD003674.
38.	Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop, 2012, 36(4): 765-773.
39.	Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl), 2011, 124(23): 4050-4055.
40.	Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
41.	Kearney RS, Costa ML. Current concepts in the rehabilitation of an acute rupture of the tendo Achillis. J Bone Joint Surg (Br), 2012, 94(1): 28-31.

1. Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg, 2008, 97(3): 272-275.
2. Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med, 1999, 9(3): 157-160.
3. Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Joint Surg (Br), 2011, 93(8): 1071-1078.
4. Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
5. Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg (Am), 1981, 63(3): 394-399.
6. Gwynne-Jones DP, Sims M, Handcock D. Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int, 2011, 32(4): 337-343.
7. Suchak AA, Bostick G, Reid D, et al. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int, 2005, 26(11): 932-936.
8. Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle, 1985, 6(1): 34-38.
9. Maffulli N. Achilles tendon rupture. Br J Sports Med, 1995, 29(4): 279-280.
10. Williams JG. Achilles tendon lesions in sport. Sports Med, 1993, 16(3): 216-220.
11. McQuillan R, Gregan P. Tendon rupture as a complication of corticosteroid therapy. Palliat Med, 2005, 19(4): 352-353.
12. Seeger JD, West WA, Fife D, et al. Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population. Pharmacoepidemiol Drug Sa, 2006, 15(11): 784-792.
13. Wilson AM, Goodship AE. Exercise-induced hyperthermia as a possible mechanism for tendon degeneration. J Biomech, 1994, 27(7): 899-905.
14. Birch HL, Wilson AM, Goodship AE. The effect of exercise-induced localised hyperthermia on tendon cell survival. J Exp Biol, 1997, 200(Pt 11): 1703-1708.
15. Arner O, Lindholm A. Subcutaneous rupture of the Achilles tendon; a study of 92 cases. Acta Chir Scand Suppl, 1959, 116(Supp 239): 1-51.
16. 王亦璁. 骨与关节损伤. 北京: 人民卫生出版社, 2007: 1491.
17. 胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 3版. 北京: 人民军医出版社, 2005: 816.
18. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res, 1977, (128): 247-255.
19. Gigante A, Moschini A, Verdenelli A, et al. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc, 2008, 16(2): 204-209.
20. Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int, 2001, 22(7): 559-568.
21. Henríquez H, Muñoz R, Carcuro G, et al. Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res, 2012, 470(4): 998-1003.
22. Maffulli N, Longo UG, Ronga M, et al. Favorable outcome of percutaneous repair of achilles tendon ruptures in the elderly. Clin Orthop Relat Res, 2010, 468(4): 1039-1046.
23. Chan AP, Chan YY, Fong DT, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3(1): 32.
24. Majewski M, Rohrbach M, Czaja S, et al. Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med, 2006, 34(5): 793-798.
25. Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med, 2005, 33(9): 1369-1379.
26. McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg, 2011, 17(4): 211-217.
27. Khan RJ, Fick D, Brammar TJ, et al. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2004, (3): CD003674.
28. Möller M, Movin T, Granhed H, et al. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg (Br), 2001, 83(6): 843-848.
29. Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg (Br), 2011, 93(10): 1362-1366.
30. Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med, 2008, 36(9): 1688-1694.
31. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg (Am), 2010, 92(17): 2767-2775.
32. Garrick JG. Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute achilles tendon ruptures? Clin J Sport Med, 2012, 22(4): 379-380.
33. Karkhanis S, Mumtaz H, Kurdy N. Functional management of Achilles tendon rupture: A viable option for non-operative management. Foot Ankle Surg, 2010, 16(2): 81-86.
34. Costa ML, Macmillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
35. Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med, 2010, 38(11): 2186-2193.
36. Bhandari M, Guyatt GH, Siddiqui F, et al. Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res, 2002, (400): 190-200.
37. Khan RJ, Carey Smith R. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2010, (9): CD003674.
38. Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop, 2012, 36(4): 765-773.
39. Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl), 2011, 124(23): 4050-4055.
40. Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
41. Kearney RS, Costa ML. Current concepts in the rehabilitation of an acute rupture of the tendo Achillis. J Bone Joint Surg (Br), 2012, 94(1): 28-31.

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