Face Off: Surgical Versus Nonsurgical Treatment of Acute Achilles Tendon Ruptures

The Achilles tendon (AT) is the most commonly ruptured tendon  in the human body. The incidence of AT ruptures has increased in recent decades,  with the number of reported ruptures per 100,000 people in North America now ranging  from 5.5 to 9.9. Most acute AT ruptures occur as a result of trauma or athletic  activity. Other described mechanisms include unexpected dorsiflexion, push-off with  the knee in extension and forced dorsiflexion of a plantarflexed foot. Some studies  demonstrate differences in less active individuals, with an increased incidence  in the third and fourth decades of life in men and in the sixth decade of life in  women.

  The AT typically ruptures approximately 3 cm from its calcaneal  insertion, likely secondary to decreased vascularity in this region. A 2004 study  reported a 6 percent to 26 percent chance of contralateral rupture, with males experiencing  a higher rate of rupture than females. A history and physical exam are usually sufficient  for diagnosis, with the Thompson test demonstrating the greatest sensitivity. The  presence of a palpable gap and loss of plantarflexion strength may also aid in diagnosis  but are much less sensitive.

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