Current Concepts in the Management of Achilles Tendon Injuries
Main Article Content
Keywords
Achilles Tendon Injuries, Current Concepts , Management.
Abstract
Achilles tendon injuries are commonly encountered in orthopaedic practice. The Achilles tendon is prone to rupture, and this negatively imparts ambulation. The diagnosis is clinical. Treatment options have evolved from conservative to surgeries, however there is no consensus on the most superior option of treatment. This narrative review aims to highlight the evolution in clinical diagnosis and treatment of Achilles tendon ruptures and discuss the current evidence in the treatment with emphasis on outcome measures of each treatment modality. Relevant studies on Achilles tendon ruptures with emphasis on treatment options, their strengths and weaknesses were reviewed. The treatment of Achilles tendon rupture has evolved from conservative options to surgeries. The surgical options include open repair, percutaneous repair, endoscopic repair, and ultrasound-guided repair. However, there is still no consensus on the most superior option for treating Achilles tendon injuries. Each method has its pros and cons. Conservative treatment has the appeal of the absence of scars, low cost and shorter duration of hospital stay. However, ankle stiffness, and late return to work are important drawbacks. Open surgery has the advantage of early return to function and low re-intervention rates. Surgical scars, likelihood of infection and cost are major disadvantages. Appropriate patient selection guided by the severity of the injury, the age of the patient, pre-injury status, work demand for the patient, experience of the surgeon, available resources, local soft tissue condition, and the patient’s preferences are key to successful outcome.
References
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3. Moller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67(5):479–481.
4. Nillius SA, Nilsson BE, Westlin NE. The incidence of Achilles tendon rupture. Acta Orthop Scand. 1976;47(1):118–121.
5. Gupta H, Shrestha R, Bicycle-spoke injuries of the foot and ankle: A prospective study. Journal of College of Medical Sciences-Nepal 2014 9(4) 10.3126/jcmsn.v9i4.10236.
6. Klenerman L. The early history of tendo Achillis and its rupture. J Bone Joint Surg Br. 2007;89:545–7. doi: 10.1302/0301-620X.89B4.18978.
7. Rang M. Orthopedics: The story of orthopaedics. JAMA. 2001;285:1643–4.
8. Chen-Chie Wang a,b, Pei-Yu Chen c, Kai-Chiang Yang d, Chung-Li Wang c,*, Ing-Ho Chen. Current treatment concepts for Achilles tendon rupture. Tzu Chi Med J 2024 12;36(1):46–52.
9.Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal SB. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Joint J 2017;99-B:78-86.
10. Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013: a nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc 2016;24:3730-3737
11.Nilsson-Helander K, Silbermagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, Karlson J. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 2010 Nov; 38(11):2186-93.
12.Heikkinen J, Lantto I, Flinkkila T, Ohtonen P, Niinimaki J, Siira P, Laine V, Leppilahti J. Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments. Am J Sports Med. 2017 May;45(6):1395-1404. doi: 10.1177/0363546517694610. Epub 2017 Mar 10. PMID: 28282504.
13. Houshian S, Tscherning T, Riegels-Nielsen P. The epidemiology of Achilles tendon rupture in a Danish county. Injury. 1998;29(9):651–654.
14. Movin T, Ryberg A, McBride D, Maffulli N. Acute rupture of the Achilles tendon. Foot Ankle Clin. 2005;10(2):331–356.
15.Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957 Jul;179(1069):56–58. PMID: 13453094.
16.Thompson TC, Doherty J H. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma. 1962 Mar;2:126–129.
17.O'Brien T. The needle test for complete rupture of the Achilles tendon. J Bone Joint Surg Am. 1984 Sep;66(7):1099–1101
18. Copeland SA. Rupture of the Achilles tendon: a new clinical test. Ann R Coll Surg Engl. 1990 Jul;72(4):270-1. PMID: 2382951; PMCID: PMC2499219
19. Fornage BD. Achilles tendon: US examination. Radiology. 1986 Jun;159(3):759–764. doi: 10.1148/radiology.159.3.3517959
20. Laine HR., Harjula AL, Peltokallio P. Ultrasonography as a differential diagnostic aid in achillodynia. J Ultrasound Med. 1987 Jul;6(7):351–362. doi: 10.7863/jum.1987.6.7.351
21. Reinig JW, Dorwart RH, Roden WC. MR imaging of a ruptured Achilles tendon. J Comput Assist Tomogr. 1985 Nov-Dec;9(6):1131–1134. doi: 10.1097/00004728-198511000-00029.
22. Thevendran G, Sarraf K, Patel N, Sadri A, Rosenfeld P. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg. 2013;97(1):9–20.
23. Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures Cochrane Database Syst Rev. 2010 Sep 8; (9):CD003674.
24. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010 Nov;38(11):2186-93. doi: 10.1177/0363546510376052. Epub 2010 Aug 27. PMID: 20802094.
25. Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, Karlsson J. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med. 2013 Dec;41(12):2867-76. doi: 10.1177/0363546513503282. Epub 2013 Sep 6. PMID: 24013347.
26. Ståle B. Myhrvold, Espen F. Brouwer, Tor K. M. Andresen, Karin Rydevik, P.T.,Madeleine Amundsen, Wolfram, Faisal B, Morten V, Svend U, Sigurd E. Hoelsbrekken. Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture. N Engl J Med 2022; 386 (5):1409-1420
27. Costa ML, Achten J, Marian IR, Dutton SJ, Lamb SE, Ollivere B, Maredza M, Petrou S, Kearney RS; UKSTAR trial collaborators. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3. PMID: 32035553; PMCID: PMC7016510.
28. Westin O, Sjögren T, Svedman S, Horvath A, Hamrin Senorski E, Samuelsson K, Ackermann P. Treatment of acute Achilles tendon rupture - a multicentre, non-inferiority analysis. BMC Musculoskelet Disord. 2020 Jun 8;21(1):358. doi: 10.1186/s12891-020-03320-3. Erratum in: BMC Musculoskelet Disord. 2021 Feb 16;22(1):193. doi: 10.1186/s12891-021-04045-7. PMID: 32513228; PMCID: PMC7282056
29. Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, Heng M, van der Meijden O, Groenwold RHH, Houwert RM. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019 Jan 7;364:k5120. doi: 10.1136/bmj.k5120. PMID: 30617123; PMCID: PMC6322065.
30. Arner O, Lindholm A. Subcutaneous rupture of the Achilles tendon; a study of 92 cases. Acta Chir Scand Suppl. 1959;116:1–51.
31. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993;21:791–9. doi: 10.1177/036354659302100606
32. Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB. Clinical outcomes and complications of percutaneous Achilles repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int. 2015;36(11):1279–1286.
33. Kessler’s description of the grasping technique of tendon repair. (Reprinted with permission from Kessler I. The “grasping” technique for tendon repair. Hand 1973;5(3):253–255.)
34. Urbaniak JR, Cahill JD, Mortenson RA. Tendon suturing methods: analysis of tensile strengths. In: AAOS Symposium on Tendon Surgery in the Hand. St. Louis, MO: CV Mosby; 1975:70–80.
35. Sebastin SJ, Ho A, Karjalainen T, Chung KC. History and evolution of the Kessler repair. J Hand Surg Am. 2013 Mar;38(3):552-61. doi: 10.1016/j.jhsa.2012.11.033.
36. McKeon BP, Heming JF, Fulkerson J, Langeland R. The Krackow stitch: A biomechanical evaluation of changing the number of loops versus the number of sutures. Arthroscopy. 2006;22:33–7. doi: 10.1016/j.arthro.2005.10.008.
37. Batista JP, Abdelatif NM, Del Vecchio JJ, Diniz P, Pereira H. Endoscopic flexor hallucis longus transfer for the management of acute Achilles tendon ruptures: A prospective case series report with a minimum of 18 months’ follow-up. J Foot Ankle Surg. 2020;59:927–37. doi: 10.1053/j.jfas.2019.12.008.
38. Pérez Teuffer A. Traumatic rupture of the Achilles tendon. Reconstruction by transplant and graft using the lateral peroneus Brevis. Orthop Clin North Am. 1974;5:89–93.
39. Wapner KL, Pavlock GS, Hecht PJ, Naselli F, Walther R. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle. 1993;14:443–9. doi: 10.1177/107110079301400803.
40. Pulvertaft RG. Repair of tendon injuries in the hand. Ann R Coll Surg Engl. 1948;3:3–14
41. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–75. doi: 10.1177/03635465020300041701.
42. Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–80. doi: 10.1302/0301-620x.81b5.9784.
43. Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P. Limited open repair of Achilles tendon ruptures: A technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002;84:161–70.
44. Chiu CH, Yeh WL, Tsai MC, Chang SS, Hsu KY, Chan YS. Endoscopy-assisted percutaneous repair of acute Achilles tendon tears. Foot Ankle Int. 2013;34:1168–76. doi: 10.1177/1071100713484005.
45. Rungprai C, Phisitkul P. Outcomes and complications following endoscopically assisted percutaneous Achilles tendon repair. Arthroscopy. 2018;34:1262–9. doi: 10.1016/j.arthro.2017.09.027.
46. Lui TH. Editorial commentary: Is endoscopy really helpful during repair of acute rupture of the Achilles tendon? Arthroscopy. 2018;34:1270–1. doi: 10.1016/j.arthro.2017.11.017
47. Liu CY, Wu TC, Yang KC, Li YC, Wang CC. Ultrasonography-guided minimally invasive surgery for Achilles sleeve avulsions. Foot Ankle Int. 2021;42:544–53. doi: 10.1177/1071100720975717.
48. Wang CC, Chen PY, Wang TM, Wang CL. Ultrasound-guided minimally invasive surgery for Achilles tendon rupture: Preliminary results. Foot Ankle Int. 2012;33:582–90. doi: 10.3113/FAI.2012.0582.
49. Wang CL, Chen PY, Yang KC, Wu HC, Wang CC. Ultrasound-guided minimally invasive surgical resection of retrocalcaneal bursitis: A preliminary comparison with traditional open surgery. J Foot Ankle Surg. 2019;58:855–60. doi: 10.1053/j.jfas.2018.12.023.
50. 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.
51. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Epub 2010 Oct 29. PMID: 21037028.
52. Barfod K, Bencke J, Lauridsen H, Ban I, Ebskov L, Troelsen A. Nonoperative dynamic treatment of acute achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. J Bone Joint Surg Am. 2014;96(18):1497–1503.
53. Kauwe M. Acute Achilles tendon rupture: clinical evaluation, conservative management, and early active rehabilitation. Clin Podiatr Med Surg. 2017;34(2):229–243.
2. Illies H, Chalmers J. The management of fresh ruptures of the tendo achillis. J Bone Joint Surg Am. 1970;52(2):337–34.
3. Moller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67(5):479–481.
4. Nillius SA, Nilsson BE, Westlin NE. The incidence of Achilles tendon rupture. Acta Orthop Scand. 1976;47(1):118–121.
5. Gupta H, Shrestha R, Bicycle-spoke injuries of the foot and ankle: A prospective study. Journal of College of Medical Sciences-Nepal 2014 9(4) 10.3126/jcmsn.v9i4.10236.
6. Klenerman L. The early history of tendo Achillis and its rupture. J Bone Joint Surg Br. 2007;89:545–7. doi: 10.1302/0301-620X.89B4.18978.
7. Rang M. Orthopedics: The story of orthopaedics. JAMA. 2001;285:1643–4.
8. Chen-Chie Wang a,b, Pei-Yu Chen c, Kai-Chiang Yang d, Chung-Li Wang c,*, Ing-Ho Chen. Current treatment concepts for Achilles tendon rupture. Tzu Chi Med J 2024 12;36(1):46–52.
9.Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal SB. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Joint J 2017;99-B:78-86.
10. Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013: a nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc 2016;24:3730-3737
11.Nilsson-Helander K, Silbermagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, Karlson J. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 2010 Nov; 38(11):2186-93.
12.Heikkinen J, Lantto I, Flinkkila T, Ohtonen P, Niinimaki J, Siira P, Laine V, Leppilahti J. Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments. Am J Sports Med. 2017 May;45(6):1395-1404. doi: 10.1177/0363546517694610. Epub 2017 Mar 10. PMID: 28282504.
13. Houshian S, Tscherning T, Riegels-Nielsen P. The epidemiology of Achilles tendon rupture in a Danish county. Injury. 1998;29(9):651–654.
14. Movin T, Ryberg A, McBride D, Maffulli N. Acute rupture of the Achilles tendon. Foot Ankle Clin. 2005;10(2):331–356.
15.Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957 Jul;179(1069):56–58. PMID: 13453094.
16.Thompson TC, Doherty J H. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma. 1962 Mar;2:126–129.
17.O'Brien T. The needle test for complete rupture of the Achilles tendon. J Bone Joint Surg Am. 1984 Sep;66(7):1099–1101
18. Copeland SA. Rupture of the Achilles tendon: a new clinical test. Ann R Coll Surg Engl. 1990 Jul;72(4):270-1. PMID: 2382951; PMCID: PMC2499219
19. Fornage BD. Achilles tendon: US examination. Radiology. 1986 Jun;159(3):759–764. doi: 10.1148/radiology.159.3.3517959
20. Laine HR., Harjula AL, Peltokallio P. Ultrasonography as a differential diagnostic aid in achillodynia. J Ultrasound Med. 1987 Jul;6(7):351–362. doi: 10.7863/jum.1987.6.7.351
21. Reinig JW, Dorwart RH, Roden WC. MR imaging of a ruptured Achilles tendon. J Comput Assist Tomogr. 1985 Nov-Dec;9(6):1131–1134. doi: 10.1097/00004728-198511000-00029.
22. Thevendran G, Sarraf K, Patel N, Sadri A, Rosenfeld P. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg. 2013;97(1):9–20.
23. Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures Cochrane Database Syst Rev. 2010 Sep 8; (9):CD003674.
24. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010 Nov;38(11):2186-93. doi: 10.1177/0363546510376052. Epub 2010 Aug 27. PMID: 20802094.
25. Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, Karlsson J. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med. 2013 Dec;41(12):2867-76. doi: 10.1177/0363546513503282. Epub 2013 Sep 6. PMID: 24013347.
26. Ståle B. Myhrvold, Espen F. Brouwer, Tor K. M. Andresen, Karin Rydevik, P.T.,Madeleine Amundsen, Wolfram, Faisal B, Morten V, Svend U, Sigurd E. Hoelsbrekken. Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture. N Engl J Med 2022; 386 (5):1409-1420
27. Costa ML, Achten J, Marian IR, Dutton SJ, Lamb SE, Ollivere B, Maredza M, Petrou S, Kearney RS; UKSTAR trial collaborators. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3. PMID: 32035553; PMCID: PMC7016510.
28. Westin O, Sjögren T, Svedman S, Horvath A, Hamrin Senorski E, Samuelsson K, Ackermann P. Treatment of acute Achilles tendon rupture - a multicentre, non-inferiority analysis. BMC Musculoskelet Disord. 2020 Jun 8;21(1):358. doi: 10.1186/s12891-020-03320-3. Erratum in: BMC Musculoskelet Disord. 2021 Feb 16;22(1):193. doi: 10.1186/s12891-021-04045-7. PMID: 32513228; PMCID: PMC7282056
29. Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, Heng M, van der Meijden O, Groenwold RHH, Houwert RM. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019 Jan 7;364:k5120. doi: 10.1136/bmj.k5120. PMID: 30617123; PMCID: PMC6322065.
30. Arner O, Lindholm A. Subcutaneous rupture of the Achilles tendon; a study of 92 cases. Acta Chir Scand Suppl. 1959;116:1–51.
31. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993;21:791–9. doi: 10.1177/036354659302100606
32. Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB. Clinical outcomes and complications of percutaneous Achilles repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int. 2015;36(11):1279–1286.
33. Kessler’s description of the grasping technique of tendon repair. (Reprinted with permission from Kessler I. The “grasping” technique for tendon repair. Hand 1973;5(3):253–255.)
34. Urbaniak JR, Cahill JD, Mortenson RA. Tendon suturing methods: analysis of tensile strengths. In: AAOS Symposium on Tendon Surgery in the Hand. St. Louis, MO: CV Mosby; 1975:70–80.
35. Sebastin SJ, Ho A, Karjalainen T, Chung KC. History and evolution of the Kessler repair. J Hand Surg Am. 2013 Mar;38(3):552-61. doi: 10.1016/j.jhsa.2012.11.033.
36. McKeon BP, Heming JF, Fulkerson J, Langeland R. The Krackow stitch: A biomechanical evaluation of changing the number of loops versus the number of sutures. Arthroscopy. 2006;22:33–7. doi: 10.1016/j.arthro.2005.10.008.
37. Batista JP, Abdelatif NM, Del Vecchio JJ, Diniz P, Pereira H. Endoscopic flexor hallucis longus transfer for the management of acute Achilles tendon ruptures: A prospective case series report with a minimum of 18 months’ follow-up. J Foot Ankle Surg. 2020;59:927–37. doi: 10.1053/j.jfas.2019.12.008.
38. Pérez Teuffer A. Traumatic rupture of the Achilles tendon. Reconstruction by transplant and graft using the lateral peroneus Brevis. Orthop Clin North Am. 1974;5:89–93.
39. Wapner KL, Pavlock GS, Hecht PJ, Naselli F, Walther R. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle. 1993;14:443–9. doi: 10.1177/107110079301400803.
40. Pulvertaft RG. Repair of tendon injuries in the hand. Ann R Coll Surg Engl. 1948;3:3–14
41. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–75. doi: 10.1177/03635465020300041701.
42. Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–80. doi: 10.1302/0301-620x.81b5.9784.
43. Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P. Limited open repair of Achilles tendon ruptures: A technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002;84:161–70.
44. Chiu CH, Yeh WL, Tsai MC, Chang SS, Hsu KY, Chan YS. Endoscopy-assisted percutaneous repair of acute Achilles tendon tears. Foot Ankle Int. 2013;34:1168–76. doi: 10.1177/1071100713484005.
45. Rungprai C, Phisitkul P. Outcomes and complications following endoscopically assisted percutaneous Achilles tendon repair. Arthroscopy. 2018;34:1262–9. doi: 10.1016/j.arthro.2017.09.027.
46. Lui TH. Editorial commentary: Is endoscopy really helpful during repair of acute rupture of the Achilles tendon? Arthroscopy. 2018;34:1270–1. doi: 10.1016/j.arthro.2017.11.017
47. Liu CY, Wu TC, Yang KC, Li YC, Wang CC. Ultrasonography-guided minimally invasive surgery for Achilles sleeve avulsions. Foot Ankle Int. 2021;42:544–53. doi: 10.1177/1071100720975717.
48. Wang CC, Chen PY, Wang TM, Wang CL. Ultrasound-guided minimally invasive surgery for Achilles tendon rupture: Preliminary results. Foot Ankle Int. 2012;33:582–90. doi: 10.3113/FAI.2012.0582.
49. Wang CL, Chen PY, Yang KC, Wu HC, Wang CC. Ultrasound-guided minimally invasive surgical resection of retrocalcaneal bursitis: A preliminary comparison with traditional open surgery. J Foot Ankle Surg. 2019;58:855–60. doi: 10.1053/j.jfas.2018.12.023.
50. 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.
51. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Epub 2010 Oct 29. PMID: 21037028.
52. Barfod K, Bencke J, Lauridsen H, Ban I, Ebskov L, Troelsen A. Nonoperative dynamic treatment of acute achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. J Bone Joint Surg Am. 2014;96(18):1497–1503.
53. Kauwe M. Acute Achilles tendon rupture: clinical evaluation, conservative management, and early active rehabilitation. Clin Podiatr Med Surg. 2017;34(2):229–243.
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Nov 11, 2025
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Diamond, T., & Achor, M. (2025). Current Concepts in the Management of Achilles Tendon Injuries. Nigerian Medical Journal, 66(4), 1301–1314. https://doi.org/10.71480/nmj.v66i4.878
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