Achilles tendon rupture treatment guidelines: Exercise caution

Operative treatment for patients with an Achilles tendon rupture should be approached more cautiously in persons older than 65 years and in other patient groups, according to a consensus recommendation in an evidence-based clinical practice guideline, The Diagnosis and Treatment of Acute Achilles Tendon Rupture, recently released by the American Academy of Orthopaedic Surgeons (AAOS). Others for whom exercising extra caution is recommended include patients who have sedentary lifestyles; obese persons; those with immunocompromised status; cigarette smokers; and patients who have diabetes mellitus, neuropathy, or a vascular disorder. No evidence was found to support the use of biologic agents, autograft, or synthetic tissue with surgical repair of Achilles tendon ruptures.

The guideline contains 16 recommendations. Another consensus recommendation calls for performance of a detailed history and physical examination in the absence of reliable evidence to establish the diagnosis of acute Achilles tendon rupture. The physical examination should include 2 or more of the following tests and assessments:

•Clinical Thompson test (Simmonds squeeze test).

•Decreased ankle plantar flexion strength.

•Presence of a palpable gap (defect, loss of contour).

•Increased passive ankle dorsiflexion with gentle manipulation.

Inconclusive evidence-based research was identified for recommending for or against the routine use of ultrasonography, radiography, or MRI to confirm a diagnosis of acute Achilles tendon rupture. Other recommendations that lacked conclusive evidence include the following:

•The use of physical therapy after surgery.

•A specific time frame in which patients can return to activities of daily living regardless of treatment type.

•A specific time frame in which patients can return to athletic activity when they are treated without surgery.

A need for further high-level research was identified for the following recommendations:

•Operative treatment may be used to treat patients with Achilles tendon rupture.

•Minimally invasive repair of the Achilles tendon offers possible advantages.

•Nonoperative management (with braces or casts) may result in acceptable outcomes.

To see the full guideline, visit the AAOS Web site at http://aaos.org. Or, contact the organization at American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262; telephone: (847) 823-7186; fax: (847) 823-8125.