Treatment of Acute Achilles Tendon Rupture

The Achilles tendon is the strongest and largest tendon in the body, but it is also the most commonly ruptured tendon.The overall incidence of Achilles tendon rupture is on the rise recently 1,2) because of the aging of the population, growing prevalence of obesity, and increased participation in sports. 3)ontroversy has surrounded the optimal treatment of acute Achilles tendon rupture. 4)[7][8] These studies provided a rationale for operative treatment of acute rupture of the Achilles tendon, despite the risk of complications from surgery such as wound infection.However, recent studies have demonstrated favorable outcomes of conservative treatment using accelerated functional rehabilitation.][11] Currently, regardless of the treatment modality-either conservative or opera-tive-used, aggressive early rehabilitation is advocated for acute Achilles tendon ruptures to allow for an early return to activities of daily living, high patient satisfaction, and functional improvement.In this review article, we provide a comprehensive review of the literature on acute rupture of the Achilles tendon and discuss appropriate treatment options. EPIDEMIOLOGYAchilles tendon rupture accounts for 20% of all large tendon ruptures. 12)][15] Men are 2 to 12 times more prone to Achilles tendon rupture than women. 16)In a 2012 meta-analysis by Soroceanu et al.,10) the mean age at the time of injury among 826 patients with an acute Achilles tendon rupture was 39.8 years.The injury has a bimodal age distribution with the first peak in patients between 25 years and 40 years of age and the second peak in those over 60 years. 17,18)High-energy injuries in sports are responsible for the first peak, whereas the second peak occurring in the elderly is mostly associated with low-energy injuries, such as spontaneous rupture of the degenerated Achilles tendon or rupture in chronic Achilles tendinopathy.In young patients with acute sports injures, conservative management is usually sufficient for tendon healing.However, rupture of the degenerated tendon in the elderly requires a different treatment approach because the tendon remains vulnerable to rerupture even after operative