Acute Achilles tendon rupture

Abstract

Achilles tendon rupture is a common sports-related injury, with the incidence of acute ruptures continuing to increase. Achilles ruptures can be missed, or presentation may be delayed. Clinical tests assist diagnosis, with the Thompson and Matles tests being the most sensitive and specific. Ultrasound provides a valuable adjunct for diagnosing acute Achilles tendon ruptures. Traditionally, operative management has led to lower re-rupture rates than conservative treatment, but surgery increases the risk of complications such as adhesions and wound infection. More recently, however, non-operative treatment consisting of early mobilisation and rehabilitation, produces comparable re-rupture rates and functional outcomes to surgery. Percutaneous surgery may reduce the risk of operative complications, but needs to be more widely practised. In the present review we discuss the anatomy, aetiology, mechanism of injury, clinical assessment and investigations for diagnosing acute Achilles tendon ruptures. The debate regarding operative versus non-operative management is also considered.