Achilles Tendon Rupture – What Have We Learnt So Far?

Controversy exists over the optimal way to manage some types of Achilles tendon (AT) rupture: this lecture will review the current best evidence to help inform decision-making.

While surgery is indicated with complete ruptures (Type I), some partial (Type II and III) injuries may be amenable to conservative management, although no randomized controlled studies have been published to directly compare outcomes. A systematic review of the evidence comparing surgical and non-surgical management of AT rupture in people was undertaken by Erickson et al (2015); nine eligible studies were identified, involving 5842 patients. Perhaps predictably, seven studies identified a higher rate of re-rupture in the non-operative group and a higher rate of complications in the operative group. These findings are likely to be equally applicable to veterinary patients.

The question of whether it is necessary to repair partial AT ruptures, or to simply immobilize the hock in extension, remains unanswered. When repair is undertaken, an attempt should be made to suture the individual tendons, although in chronic cases, resection of unhealthy tendon and subsequent suturing of the tendons en masse may be necessary. In either case, atraumatic manipulation of the tendons is essential to avoid further compromise to the blood supply. However, studies on the vascularity of the tendons have produced conflicting results. Work by Gilbert et al (2010), demonstrated that fine branches of the caudal saphenous artery enter the mid-body of the tendon along the cranial border, with additional branches from the gastrocnemius muscles supplying the musculotendinous junction, and vessels extending 2-3cms proximally from the calcaneus into the tendon. These authors reported significantly higher mean total vessel counts for the insertion than all other sections. In contrast, a study by Jopp and Reese (2009) suggested that the insertion of the gastrocnemius may instead be relatively avascular.  [...]