Parsing Through the Data on Achilles Tendon Rupture Management, Rehab and Sports Return Criteria: a Current Literature Review

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PURPOSE: To evaluate and discuss controversies that have arisen as management of acute and chronic Achilles tendon ruptures continues to evolve. Areas of debate include operative versus nonoperative treatment, best repair or reconstruction techniques, timing of post-op weightbearing protocols, and newer functional rehabilitation interventions. With the incidence of Achilles tendon ruptures increasing, the goal of this review is to provide a resource in determining best treatment options. RECENT FINDINGS: Evidence demonstrates that operative and nonoperative management yield comparable long-term functional outcomes. However, surgical repairs offer lower rerupture rates and earlier return to activity. There is a trend towards minimally invasive techniques for primary repairs, favored due to reduced wound complications and faster recovery. Earlier surgical intervention after injury shows improved functional outcomes. For chronic ruptures, flexor hallucis longus tendon transfer is the workhorse of secondary reconstruction. Early functional rehabilitation has been shown to be safe and effective across treatment strategies. The management of Achilles tendon injuries remains a complex clinical challenge that demands a comprehensive understanding of the tendon biomechanics, and distinct pathophysiological differences between acute and chronic presentations. Selection between operative and non-operative management requires individualized consideration, while adhering to evidence-based rehabilitation protocols is paramount to successful functional outcomes. Navigating these patient specific treatment options for various patient populations promotes optimal recovery in the short and long term.