Chronic Achilles Tendon Ruptures

Chronic Achilles tendon ruptures can be challenging to treat. Most of these are a result of failure to make the initial diagnosis. Although pain is not a prominent symptom, these patients have significant functional deficits that can interfere with activities of daily living. Nonoperative treatment options are limited and probably best reserved for patients with low functional demands or those with significant medical contraindications for surgical treatment. Surgical treatment of chronic rupture often involves the need to restore continuity to tendon ends that may have retracted leading to irreducible gaps. A variety of techniques have been described to address this situation. Most of the reports have shown improvement in patient outcomes with surgical intervention; however, most patients continue to show some strength deficits in comparison to their contralateral limb. The small number of patients in these studies combined with variations in patient selection, postoperative regimens, and outcome measurements make meaningful comparisons difficult. Restoration of the physiologic tension of the gastrocnemius-soleus complex is the goal of surgical intervention and controlled studies are needed to determine if one method is superior to others in the achievement of this goal.