1. Achilles Tendon Rupture
Kristoff Reid, MD
Assistant Professor, MUSC

2. Introduction and Disclaimer
CPG published 2009
Latest comprehensive review – JAAOS 2017, Kadakia Et al.
Generally similar conclusions.
Updates highlighted

3. Clinical Examination 1/4 – Consensus Physical exam should be performed
2 or more of:
Thompson test (Simmonds squeeze)
Decreased plantarflexion strength
Presence of palpable gap
Increased dorsiflexion with gentle manipulation

4. Imaging 0/4 – Inconclusive No studies of MRI or Radiographs
Two level V studies for ultrasound (unreliable data)

5. Nonoperative management
2/4 – Limited evidence (in comparison trials)
Functional outcomes positive in 1/2
Improved return to activity/sport in 1/3
1/4 showed improvement in rerupture rate
Higher complication rates in operative group

6. Functional bracing
Inconclusive Two studies. Only outcome analyzable was rerupture rate – inconclusive Update: Multiple functional bracing studies. Benefits to rerupture rates vs immobilization Overall similar outcomes to surgery with lower complications Possible diminished plantarflexion and time to activity

7. Operative Treatment 2/4 – Limited evidence (not comparison studies)
8 studies for open
6 studies for MIS
73-100% return to activity at 6 months
92% pain free at 12 months

8. Risk factors for surgery
1/4 Consensus
No studies addressing comorbidities for repair
Consider nonoperative treatment for patients with conditions that inhibit wound healing

9. Preoperative care Inconclusive
Unable to recommend for or against preop immobilization or restricted weight bearing

10. MIS
2/4 Limited Evidence
6 comparative trials demonstrated no difference in rerupture
2 studies showed no faster recovery for percutaneous
2 studies showed improved return to activity for limited open
No statistical difference in satisfaction
One percutaneous study in favor of improved wound healing

11. Biological adjuncts Inconclusive
No studies for allograft, xenograft, or biologic adjuvants
3 studies showed no benefit to autograft
1 study showed no benefit to synthetic tissue
Update: Multiple studies on biologic adjuvants, no clinical benefit demonstrated

12. DVT Prophylaxis
Inconclusive
No studies

13. Postoperative weight bearing
3/4 Moderate Evidence
Suggest early (2 weeks) protected weight bearing for operatively treated achilles tendon rupture
4 level II studies
3 studies showed improved return to activity

14. Postoperative mobilization
3/4 Moderate evidence
Suggest use of a device that allows mobilization 2-4 weeks postop
5 studies using a device that limited dorsiflexion

15. Physical Therapy
Inconclusive

16. Return to daily activity
Inconclusive

17. (Operative) Return to sports
2/4 Limited Evidence
It’s an option to return to sports 3-6 months postop

18. Nonop return to activity
Inconclusive
Unable to recommend a specific timeline to return to activity.

19. Questions