A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative
Year: 2026
Type: article
Study design: Observational Study
Abstract: PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR. METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method. RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%). CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms. LEVEL OF EVIDENCE: Level IV.
DOI: 10.1002/ksa.70327
Authors: João Vide, Francisco Santos, Sofia Dantas, Emanuel Seiça, João Caetano, Daniel Mendes, Manuel Resende Sousa, Mette Anderson, Matteo Guelfi, Choon Chiet Hong, Pim van Dijk, Pietro Spennacchio, Guillaume Cordier, Niek van Dijk, Samuel Ling, Yinghui Hua, Jordi Vega, Pedro Fernandes, Michael Carmont
Institutions: University of Lisbon, Universidade Católica Portuguesa, Hospital da Luz, Unidade Local de Saúde do Litoral Alentejano, Joaquim Chaves Saúde (Portugal), Casa di Cura Villa Bianca, Casa di Cura Città di Roma, J|medical (Italy), National University Hospital, Amsterdam UMC Location University of Amsterdam, University of Amsterdam, Centre Hospitalier de Luxembourg, Clinique du Sport, Chinese University of Hong Kong, Prince of Wales Hospital, Fudan University, Huashan Hospital, Shrewsbury and Telford Hospital NHS Trust, Keele University
Language: English
Topic: Foot and Ankle Surgery
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7128094622