Management of chronic Achilles ruptures: a scoping review

Abstract

Purpose: This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research.

Methods: A scoping review was performed according to the frameworks of Arksey and O'Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria.

Results: A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%).

Conclusion: Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient.

Keywords: Achilles; Achilles tendon rupture; Chronic rupture; Neglected rupture; Scoping review.

Fig. 1

PRISMA flow diagram displaying the number of studies retrieved following searching and removed at each screening stage

Fig. 2

Flowchart detailing the number of studies using a particular treatment technique. FHL flexor hallucis longus, FDL: flexor digitorum longus: Semitendinosus, LARS: Ligament Advanced Reinforcement System (LARS) graft (JK Orthomedic, Dollard-des-Ormeaux, Quebec, Canada. *Two studies used both a single and a double incision FHL transfer approach in different patients, seven exclusively used a single incision, nine a double incision, two an endoscopic approach and two did not specify the exact approach