Evidence-based Sports Medicine

Subcutaneous rupture of the Achilles tendongave similar rates of re-rupture (4/283, 1·4%), and the highest rates ofre-rupture were found in the conservative management andimmobilised group (62/578, 10·8%). The high re-rupture rate in theconservatively managed group has been noted in many other studieswhich may be a reason for its decline in popularity over the years.External fixation is a very seldom mentioned and rarely used means tomanage ATRs, yet in our analysis it has the least reported re-rupturerate, which is a major outcome measure when assessing the success ofmanagement of ATRs. Meticulous maintenance and follow up ofexternal fixation in other orthopaedic domains have probably affectedthe uptake of this method as a routine management option for ATRs. 134Overall, the best outcomes with regards to complication rates werefound in those patients managed with open repair and earlymobilisation (35/283, 12·4%). Complication rates using externalfixation (excluding the studies by Tomakov 29 ) were also relatively lowat 14·6% (5/41). Patients who received conservative managementwith early mobilisation and those who underwent percutaneousrepair with early mobilisation sustained high complication rates(12/67, 32·8% and 39/122, 31·9% respectively), but better functionaloutcome than those immobilised for longer durations. The majorityof these complications are minor. The other management regimes hadcomplication rates between 17·8% (44/247) and 25·7% (955/3718).Surgical techniquesDue to the large variations in surgical techniques for repair of theruptured Achilles tendon, it is nearly impossible to demonstratewhich method gives the best overall outcome. The literature tendsto favour the use of simple end to end suturing (Kessler, Bunneland Masson) which accounts for 1394/4001 (34·8%) of all opentechniques used. Other open repair techniques usually use end to endtechniques with additional peripheral reinforcement.The Ma and Griffiths 17 repair and Delponte technique 51 are themost commonly used percutaneous methods accounting for 91/269(33·8%) and 92/269 (34·2%) of percutaneous repairs. The popularityof these techniques probably bear witness to their simplicity. Ingeneral, it seems the simpler procedures are more favourable.ConclusionOperative management is the most common management modalityreported following spontaneous rupture of the Achilles tendon inrelatively young patients. Open repair and early mobilisation is531