Rupture of the Achilles tendon

The Achilles tendon is the strongest tendon in the body and also the most commonly ruptured tendon in the lower extremity of the body (1).

• disruption in the conjoined tendon of the gastrocnemius and soleus muscles occurs with rupture of the tendon
• commonly occurs 2-6 cm proximal to the tendon insertion into the calcaneus (which corresponds to a watershed region of poor vascularisation) (2).

Incidence is roughly thought to be up to 40 per 100,000 (3).

• incidence of Achilles tendon rupture is increasing each year.
• mean age of presentation is 35 years with a male to female ratio estimated to range from 1.7:1 to 30:1

Risk factors for tendon ruptures include: (4)

• increasing age
• Achilles tendinopathy
• systemic corticosteroids
• previous steroid injections into or around the Achilles tendon
• use of quinolone antibiotics

Spectrum of Achilles tendon ruptures consist of: (5)

• acute rupture - frequently seen in middle aged men (in their third and fourth decades of life) who participate in sporting activities occasionally
• chronic rupture - in some patients the rupture might not be recognized at the initial presentation which will result in a delayed presentation of four to six weeks and also from overuse injuries stemming from inflammatory and degenerative changes within the tendon itself

Most ruptures are seen during strenuous physical activities like playing basketball, tennis, football and softball. (5)

A rupture of the Achilles tendon may be:

• partial
• complete

Reference:

1. Yasui Y et al. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. Biomed Res Int. 2017;2017:7021862.
2. Cao S, Teng Z, Wang C, Zhou Q, Wang X, Ma X. Influence of Achilles tendon rupture site on surgical repair outcomes. J Orthop Surg (Hong Kong). 2021 Jan-Apr;29(1)
3. Meulenkamp B, Stacey D, Fergusson D, Hutton B, Mlis RS, Graham ID. Protocol for treatment of Achilles tendon ruptures; a systematic review with network meta-analysis. Syst Rev. 2018 Dec 23;7(1):247
4. Egger AC, Berkowitz MJ. Achilles tendon injuries. Curr Rev Musculoskelet Med. 2017 Mar;10(1):72-80.
5. Maffulli N, Via AG, Oliva F. Chronic Achilles Tendon Rupture. Open Orthop J. 2017;11:660-669