A Survey on Management of Chronic Achilles Tendon Ruptures

No controlled trials regarding man­agement of chronic Achilles ten­don ruptures have been published. We conducted an online survey of orthopedic surgeons affiliated with US medical schools.

One hundred twenty-seven sur­geons responded, but not all respond­ed to each survey question. Thirty-six percent had foot and ankle fellowship training. Nearly all respondents diag­nosed tendon rupture by using palpa­tion of the tendon gap (97%) and the Thompson calf-squeeze test (96%). The Matles test was used by 37% of respondents, with foot and ankle specialists nearly 5 times more likely to use it than nonspecialists (P<.001). For surgical repair of a ruptured ten­don, most surgeons used the end-to-end Bunnell technique for gaps of a few centimeters, transitioning to the flexor hallucis longus procedure or V-Y tendinoplasty for larger gaps. Ninety-three percent of respondents used nonabsorbable sutures; absorb­able suture use tended to increase with years of practice. Most sur­geons (72%) preferred postoperative immobilization for up to 6 weeks and non–weight-bearing for up to 6 weeks (96%).

In most instances, the responses of foot and ankle specialists did not differ significantly from those of other orthopedic surgeons, allowing generalization of the survey results to practice trends among all ortho­pedic surgeons. Practice trends tended to follow published expert opinions.