Surgical management of chronic ruptures of the Achilles tendon remains unclear: a systematic review of the management options.

BACKGROUND: Chronic ruptures of the Achilles tendon cause marked functional impairment. Given the different repair techniques used, there is a need for a systematic review of the literature to investigate whether these procedure are comparable with one another when performed by experienced surgeons. SOURCES OF DATA: A systematic literature search using the Medline (Pubmed), EMBASE and CINHAL databases. AREAS OF AGREEMENT: Provided there are no contraindications, surgery is regarded the best management option. AREAS OF CONTROVERSY: Most reports are case series with small sample sizes using non-validated measures. GROWING POINTS: Long-term results of surgical repair procedures are now available. AREAS TIMELY FOR DEVELOPING RESEARCH: The current literature does not allow clinicians to definitively determine the optimal management modality for chronic rupture of the Achilles tendon. There is a need for randomized controlled trials which use validated functional outcome measures.