Chou: OKU: Foot and Ankle 7

Section 7: Tendon Disorders and Sports-Related Foot and Ankle Injuries

with an Achilles tendon rupture. Orthop J Sports Med 2016;4(10):2325967116667920. 8. Willits K, Amendola A, Bryant D, et al: Operative versus nonoperative treatment of acute Achilles tendon ruptures: A multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 2010;92(17):2767-2775. 9. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M: Surgical versus nonsurgical treatment of acute Achilles tendon rupture: A meta-analysis of randomized trials. J Bone Joint Surg Am 2012;94(23):2136-2143. 10. Meulenkamp B, Woolnough T, Cheng W, et al: What is the best evidence to guide management of acute Achilles tendon ruptures? A systematic review and network meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2021;479(10):2119-2131. A meta-analysis of 19 randomized controlled trials compared two or more of the following interventions for treatment of acute Achilles tendon rupture: primary immobilization, func tional rehabilitation, open surgical repair, minimally invasive repair. The authors found an increased risk of rerupture with primary immobilization compared with open repair (odds ratio, 4.06); however, no difference in rerupture rates was found among the other treatments. Minimally invasive repair was associated with the lowest rate of complications that resulted in additional surgery in this analysis. Level of evidence: I. 11. Deng S, Sun Z, Zhang C, Chen G, Li J: Surgical treatment ver sus conservative management for acute Achilles tendon rup ture: A systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg 2017;56(6):1236-1243. 12. Myhrvold SB, Brouwer EF, Andresen TKM, et al: Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl J Med 2022;386(15):1409-1420. This is a randomized controlled trial of 526 patients who underwent treatment for an acute Achilles tendon rupture with nonsurgical management, open repair, or minimally invasive surgery. No difference in patient-reported outcome (Achilles Tendon Total Rupture Score) was found between groups at 12 months. Nonsurgical treatment was associated with higher risk of rerupture (6.2%) than either surgical group (0.6% in each), and a lower risk of nerve injury. Level of evidence: I. 13. Wang D, Sandlin MI, Cohen JR, Lord EL, Petrigliano FA, SooHoo NF: Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12,570 patients in a large healthcare database. Foot Ankle Surg 2015;21(4):250-253. 14. 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 nation wide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc 2016;24(12):3730-3737. 15. Patel VC, Lozano-Calderon S, McWilliam J: Immediate weight bearing after modified percutaneous Achilles tendon repair. Foot Ankle Int 2012;33(12):1093-1097.

ANNOTATED REFERENCES 1. Raikin SM, Garras DN, Krapchev PV: Achilles tendon injuries in a United States population. Foot Ankle Int 2013;34(4):475-480. 2. Gwynne-Jones DP, Sims M, Handcock D: Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int 2011;32(4):337-343. 3. Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H: MRI is unnecessary for diagnosing acute Achilles tendon ruptures: Clinical diagnostic criteria. Clin Orthop Relat Res 2012;470(8):2268-2273. 4. Wallace RGH, Heyes GJ, Michael ALR: The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br 2011;93(10):1362-1366. 5. Keating JF, Will EM: Operative versus non-operative treat ment of acute rupture of tendo Achillis: A prospective ran domised evaluation of functional outcome. J Bone Joint Surg Br 2011;93(8):1071-1078. 6. Nilsson-Helander K, Silbernagel KG, Thomeé R, et al: Acute Achilles tendon rupture: A randomized, controlled study com paring surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 2010;38(11):2186-2193. 7. Westin O, Nilsson Helander K, Gravare Silbernagel K, Moller M, Kalebo P, Karlsson J: Acute ultrasonography investigation to predict reruptures and outcomes in patients KEY STUDY POINTS • The Achilles tendon is the thickest and strongest tendon in the body and is subjected to high forces during activity. The central area of relative hypovas cularity in the tendon is prone to the development of pathology. • Controversy exists as to whether acute Achilles ten don ruptures are best managed surgically or non surgically. Functional rehabilitation is important in optimizing outcomes with both forms of treatment, with recent evidence indicating that early weight bearing may be more beneficial than early motion. • Management of chronic Achilles tendon ruptures depends on the size of the gap between tendon ends. Tendon transfers provide both graft mate rial to fill the gap and power from its associated muscle unit. • Surgical management of Achilles tendinopathy may be warranted after failure of nonsurgical treat ment. A variety of surgical techniques have been described with insufficient evidence to show clear superiority of one over the other.

Section 7: Tendon Disorders and Sports Related Foot and Ankle Injuries

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Orthopaedic Knowledge Update ® : Foot and Ankle 7