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Current Concepts Review   |    
Management of Chronic Ruptures of the Achilles Tendon
Nicola Maffulli, MD, MS, PhD, FRCS(Orth)1; Adam Ajis, MRCSEd2
1 Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent ST4 7QB Staffs, England. E-mail address: n.maffulli@keele.ac.uk
2 Department of Trauma and Orthopaedic Surgery, Macclesfield District General Hospital, Victoria Road, Macclesfield SK10 3BL, England
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jun 01;90(6):1348-1360. doi: 10.2106/JBJS.G.01241
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Abstract

Chronic ruptures of Achilles tendons are those that present four to six weeks after the original injury. They have become more common as acute Achilles tendon injuries have become more frequent, and they are associated with considerable functional morbidity.

Most surgeons agree that chronic ruptures should be managed operatively.

Diagnosis is based predominantly on history and clinical examination. Real-time, high-resolution ultrasound and magnetic resonance imaging are helpful in preoperative planning or as a diagnostic aid.

Local tissue, local tendons, and allografts can be used to reconstruct the tendon, and end-to-end repair is possible if the gap is <2.5 cm.

Compared with acute injuries, chronic injuries are associated with a higher rate of postoperative infection and more prolonged recovery.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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