Achilles, the warrior and hero of Homer's Iliad, lends his name to the Achilles tendon, the thickest and strongest tendon in the human body138. Thetis, Achilles's mother, made him invulnerable to physical harm by immersing him in the river Styx after learning of a prophecy that Achilles would die in battle. However, the heel by which he was held remained untouched by the water and thus Achilles had a vulnerable point. Achilles led the Greek military forces, which captured and destroyed Troy after killing the Trojan prince Hector. However, Hector's brother Paris killed Achilles by firing a poisoned arrow into his heel164.

Hippocrates, in the first recorded description of an injury to the Achilles tendon, stated that “this tendon, if bruised or cut, causes the most acute fevers, induces choking, deranges the mind and at length brings death.”26 Ambroise Pare, in 1575, recommended that a ruptured Achilles tendon be strapped with bandages dipped in wine and spices, but advised that the result was dubious27. Operative repair of a ruptured Achilles tendon was advocated in 1888 by another Frenchman, Gustave Polaillon27, although an Arabian physician performed such procedures as early as the tenth century A.D. In the twelfth century, an Italian surgeon, Guglielmo di Faliceto, believed that nature was unable to unite divided tendons and that operative treatment was necessary27.

Much research has been performed to elucidate the etiology of a rupture of the Achilles tendon, but its true nature still remains unclear190. Also, the best method of treatment is still fiercely debated. Some physicians advocate operative repair, whereas others insist that an operation is unnecessary and poses an unacceptable risk.

The tendinous portions of the gastrocnemius and soleus muscles merge to form the Achilles tendon. The plantaris …

Rupture of the Achilles Tendon

To The Editor: 

Our article “Treatment of Acute Achilles Tendon Ruptures. A Meta-Analysis of Randomized, Controlled Trials” (2005; 87:2202-10), by Khan et al., was based …

Treatment of Acute Achilles Tendon Ruptures. A Meta-Analysis of Randomized, Controlled Trials

Background: There is no consensus on the best method for management of acute Achilles tendon ruptures. Individual preferences, drawn from experience and study, determine whether treatment is operative or nonoperative.Purpose: Our goal was to review the literature to try to determine what management method was the most popular and effective. We wanted to ascertain the best results in terms of complication rates and patient outcomes.Study Design: Retrospective review of retrospectively and prospectively collected data.Methods: We analyzed 125 articles in peer-reviewed journals for year of publication, patient numbers, sex, management method, follow-up complications, and patient satisfaction. Each article was graded using a validated methods score. Methods, patient satisfaction, and complication rates were correlated with the year each article was published.Results: Skin-healing complications were lowest in conservatively managed patients (3 of 578, 0.5%) and highest in open repair and immobilized patients (...

Quantitative Review of Operative and Nonoperative Management of Achilles Tendon Ruptures

Controversy persists regarding the ideal surgical technique for repair of a ruptured Achilles tendon. We propose a limited open procedure with use of an instrument that provides the advantage of an open repair but avoids the soft-tissue problems with which open repair has been associated.

Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study.

Ma and Griffith first described in 1977 a percutaneous technique for the repair of acute Achilles tendon rupture. In 1992, Delponte popularised a new percutaneous technique with Tenolig. The authors report a series of 124 cases of Achilles tendon rupture treated with Tenolig in their institution from 1993 to 1998. There were 79 men and 45 women. The mean age was 41.5 years, with a peak from 30 to 39 years. The rupture occurred during sports activities in 69 cases. The mean duration of follow-up was 1.9 years. Surgical complications noted were: unbending of one of the harpoon wires in 5 cases, rupture of the harpoon wire in one case and tendon re-rupture in 12 cases. The rate of re-rupture was similar to the rate noted with conservative treatment (10%). Skin necrosis at the entrance wound was noted in 10 cases, and injury of the sural nerve in 8 cases. Full weight-bearing without crutches was regained for 95% of patients within 3 months. In conclusion, this report shows a high rate of re-rupture and sural nerve entrapment with percutaneous surgery (Tenolig). The high rate of re-rupture can be due to the progressive but immediate weight-bearing allowed without an orthosis, or to inadequate apposition of the tendon ends, or to delay before repair. The high rate of sural nerve entrapment is due to its proximity to the Achilles tendon. We believe that a limited open technique is more reliable and has the advantage of allowing direct visualisation of the repair site and controlling adequate apposition of the tendon ends.

Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases.

The purpose of our study was to evaluate the functional outcomes of two methods of surgical treatment of acute closed raptures of the Achilles tendon, specifically, the primary open repair and the percutaneous repair techniques, utilizing (a) isokinetic plantar flexion strength, (b) midcalf girth, (c) ankle joint proprioception, and (d) ankle range of motion values. As a secondary purpose, the frequency of reruptures and postsurgical complications were compared between techniques. Twenty male patients (mean age, 43.8 ± 9.4 years) who sustained complete, closed ruptures of the Achilles tendon participated in this study. Results of paired t tests revealed significant differences between postsurgical and contralateral normal limbs for 6 of 12 variables. Results of the ANOVAs revealed no significant differences between the open repair group and percutaneous repair group for any of the evaluative parameters. The significant deficits in postoperative isokinetic plantar flexion strength and midcalf girth measure...

Comparison of Functional Ability Following Percutaneous and Open Surgical Repairs of Acutely Ruptured Achilles Tendons

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Comparison of Functional Ability Following Percutaneous and Open Surgical Repairs of Acutely Ruptured Achilles Tendons