How I Manage "Achilles Complex" Tendinopathy

Anatomy and Pathology of Achilles complex injury
Spontaneous rupture at the distal part of the gastrocnemius tendon (GT) is the second most common non-traumatic tendon injury in dogs (Kasa, Jopp). Partial rupture, with one or more tendon components intact, is reportedly more common in dogs (Rivers). Signalment for this injury is not reported for the dog, however, in humans, there is a higher incidence among middle-aged moderately active adults and athletes.

Classification is described (Meustege) for veterinary patients as follows:

• Grade I: Complete tendon rupture resulting in plantigrade stance
• Grade IIa: Musculotendinous rupture resulting in increased flexion of the tarsus, inflammation at the musculotendinous junction
• Grade IIb: Tendon rupture with paratenon intact resulting in increased flexion of the tarsus, tense paratenon palpable
• Grade IIc: Gastrocnemius tendon avulsion from the calcaneus, with SDFT intact resulting in increased flexion of the tarsus and excessive flexion of the digits
• Grade III: Tendinosis and/or peritendinitis resulting in normal stance, but a thickened Achilles tendon

Therapeutic Approach
There is an ongoing controversy in the human literature regarding surgical repair (mini invasive suture vs. open) and conservative management using cast or brace (Neumauer, Wilkins); good to excellent results have been reported for both (Neumauer). Each approach has potential complications including re-rupture, wound infection, and implant failure. In all human cases, regardless of approach, immobilization for a period of time is recommended. In veterinary patients, surgical and nonsurgical management of this injury is described depending on the severity of injury with heavy emphasis on surgical repair (Fossum, Piermattei). Complete immobilization followed by a period of padded bandaging is recommended for veterinary patients (Nielsen, Slatter, Fossum, Piermattei).  [...]