Surgical Treatment for Chronic Disease and Disorders of the Achilles Tendon

J Am Acad Orthop Surg, Vol 17, No 1, January 2009, 3-14. Sudheer S. Reddy, MD, David I. Pedowitz, MD, MS, Selene G. Parekh, MD, MBA, Imran M. Omar, MD and Keith L. Wapner, MD

Chronic Achilles tendon disorders range from overuse syndromes to frank ruptures. Numerous forms of treatment have been used, depending on the nature of the disorder or injury. Ultrasonography and magnetic resonance imaging are commonly used for evaluation. The spectrum of disease comprises paratenonitis, tendinosis, paratenonitis with tendinosis, retrocalcaneal bursitis, insertional tendinosis, and chronic rupture. However, there is no clear consensus on what defines a chronic Achilles disorder. Nonsurgical therapy is the mainstay of treatment for most patients with overuse syndromes. Surgical techniques for overuse syndromes or chronic rupture include débridement, local tissue transfer, augmentation, and synthetic grafts. Local tissue transfer most commonly employs either the flexor hallucis longus or flexor digitorum longus tendon to treat a chronic rupture. Reports on long-term outcomes are needed before useful generalizations can be made regarding treatment.

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