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J Am Acad Orthop Surg, Vol 17, No 1, January 2009, 3-14.
© 2009 the American Academy of Orthopaedic Surgeons
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Surgical Treatment for Chronic Disease and Disorders of the Achilles Tendon

Sudheer S. Reddy, MD, David I. Pedowitz, MD, MS, Selene G. Parekh, MD, MBA, Imran M. Omar, MD and Keith L. Wapner, MD

Dr. Reddy is Sports Medicine Fellow, Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, CA. Dr. Pedowitz is Attending Physician, Department of Orthopaedic Surgery, Crystal Run Healthcare, Middletown, NY. Dr. Parekh is Assistant Professor, Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Omar is Fellow, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA. Dr. Wapner is Clinical Professor, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia.

Reprint requests: Dr. Parekh, Department of Orthopaedic Surgery, University of North Carolina School of Medicine, 3135 Bioinformatics Bldg, CB#7055, Chapel Hill, NC 27599.

Dr. Wapner or a member of his immediate family has received research or institutional support from EBI and serves as a consultant to or is an employee of Wright Medical Technology and MemoMetal. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Reddy, Dr. Pedowitz, Dr. Parekh, and Dr. Omar.

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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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.