Chronic Achilles Tendon Rupture



Nicola Maffulli1, 2, *, Alessio Giai Via3, Francesco Oliva3
1 Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy
2 Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
3 Department of Orthopaedic and Traumatology, University of Rome “Tor Vergata”, School of Medicine, Viale Oxford 81, 00133 Rome, Italy


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© 2017 Maffulli et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England; Tel: +44 7989 358 279; E-mail: n.maffulli@qmul.ac.uk


Abstract

Background:

The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries.

Methods:

This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed.

Results:

The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results.

Conclusion:

The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate.

Keywords: Achilles tendon, Chronic ruptures, Minimally-invasive surgery, Neglected injury, Tendon ruptures, Tendon transfer.