Treatment of myotendinous Achilles ruptures

Abstract

Background: There is scant literature regarding the treatment of myotendinous Achilles ruptures. The purpose of this study was to retrospectively examine clinical outcomes from uniform nonsurgical treatment of these injuries.

Methods: Between November 2005 and May 2011, 30 patients presented with an acute, complete myotendinous Achilles rupture. The location of the Achilles injury was confirmed on magnetic resonance imaging (MRI) for all patients. All patients were treated nonsurgically, which involved 3 weeks of non-weight-bearing and then 3 weeks of progressive to full weight-bearing in an Achilles boot. Physical therapy was provided for 4 to 6 weeks after this period of immobilization. 21 patients were male and 9 were female. The patients had a mean age of 40.8 years (range, 24-54). Patients were followed an average of 40.5 months (range, 23-81).

Results: Full healing of the Achilles myotendinous junction was achieved clinically in all 30 patients . All patients experienced improved function and less pain at their latest follow-up. Mean Foot and Ankle Ability Measure-Sports (FAAM-Sports) increased from 20.2% at the time of initial presentation to 95.2% at the latest follow-up (P < .05). Mean Visual Analog Scores (VAS) of pain decreased from 8.2 at the time of initial presentation to 1.3 at latest follow-up (P < .01). In all, 23 (76.7%), 6 (20%), and 1 (3.3%) patients rated their satisfaction as excellent, good, and fair, respectively. No patients have developed recurrent myotendinous Achilles ruptures to date.

Conclusion: Nonsurgical treatment of myotendinous Achilles ruptures results in a high rate of myotendinous healing with improved patient function and pain relief.

Level of evidence: Level IV, retrospective case series.

Keywords: Achilles boot; magnetic resonance imaging (MRI); nonsurgical; tendon.