Orthopaedics

1. Achilles Tendon Rupture
Conservative Management

2. Introduction
• Acute rupture of TA
– Often overlooked as “sprain”
– Missed in up to 25%
– Most common: M 30-40
– Risk factors: “weekend worriors”, smoking,
fluoroquinolone, steroids
– 4-6 cm above calcaneal insertion in hypovascular
region

3. Management – Conservative vs
Operative
• Conservative
– Funtional
bracing/casting in
equinus
– Surgeon/patient
preference
– Equivalent plantar
flexion strength vs
surgical treatment
– AVOIDS WOUND
COMPLICATIONS
– NO DIFFERENCE IN RE-
RUPTURE RATES AS PER
RECENT LEVEL 1
EVIDENCE
• Operative
– End-to-end open repair vs
percutaneous(sural n injury)
– Only for acute
ruptures(<6/52)
– VY advancement/tendon
transfer for chronic tears
– No difference in plantar
flexion strength vs
conservative treatment
– Wound problems in 5-10%
– Further surgeries required to
debride infected/necrotic
tendon in deep infections
– Does NOT avoid
bracing/casting/immobilizatio
n

17. Thank you!