Achilles Tendon Rupture Research

Key Points from peer reviewed Achilles tendon rupture research by scientists, doctors, sport trainers, educators, and physical therapists. The Achilles tendon rupture research papers listed are a selection of earlier ground breaking research, current state-of-the-art research, and research overviews. Each listing includes the research paper’s key point or points. is based on this peer reviewed Achilles tendon research.

Surgery vs. Non-Surgical Treatment of Achilles Tendon Rupture

For a summary see: Treating Achilles Tendon Injuries

Surgical interventions for treating acute Achilles tendon ruptures

Khan, RJK; Carey Smith RL. (2012) The Cochrane Library Issue 9 Key Points: Open surgical treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared with non-surgical treatment, but produces significantly higher risks of other complications such as infection, adhesions and disturbed skin sensibility (numbness and tingling). The latter may be reduced by performing percutaneous surgery rather than open surgery.

Acute Achilles Tendon Rupture – A Randomized, Controlled Study Comparing Surgical and Nonsurgical Treatments Using Validated Outcome Measures

Nilsson-Helander, Katarina; Grävare Silbernagel, Karin; Roland Thomeé, Roland; Faxén, Eva; Olsson, Nicklas; Eriksson, Bengt I.; Karlsson, Jon (2010) American Journal of Sports Medicine vol. 38 no. 11 Key Point: Ninety-seven patients (79 men, 18 women; mean age, 41 years) with acute Achilles tendon rupture were treated and followed for 1 year. The primary end point was re-rupturing. There was no statistically significant difference between surgical and nonsurgical treatment. Early mobilization is beneficial for patients with acute Achilles tendon rupture whether they are treated surgically or non-surgically.

Nonoperative Treatment of Acute Rupture of the Achilles Tendon – Results of a New Protocol and Comparison with Operative Treatment

Weber, Martin; Niemann, Marco; Lanz, Renate; Müller, Thorsten (2003) The American Journal of Sports MedicineSept. vol. 31 no. 5 685-691 Key Point: Results of operative and nonoperative treatment were equivalent.

Diagnosis and treatment of acute Achilles tendon rupture

Chiodo, CP; Glazebrook, M; Bluman, EM; Cohen, BE; Femino, JE; Giza, E; Watters, WC Goldberg, MJ;Keith, M; Haralson, RH Turkelson, CM; Wies, JL; Raymond, L; Anderson, S; Boyer, K; Sluka, P. (2010) Journal of the American Academy of Orthopaedic Surgeons  Aug;18(8):503-10 Key Points: The American Academy of Orthopaedic Surgeons approved this clinical practice guideline on December 4, 2009. This guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. None of the 16 recommendations made by the work group was graded as strong; most are graded inconclusive; four are graded weak; two are graded as moderate strength; and two are consensus statements. The two moderate-strength recommendations include the suggestions for early postoperative protective weight bearing and for the use of protective devices that allow for postoperative mobilization.

Achilles Tendon Rupture Surgery

For a summary see: Treating Achilles Tendon Injuries

Achilles tendon ruptures in elite athletes

Maffulli, N.; Longo, U.G.; Maffulli, G.D.; Khanna, A.; Denaro, V. (2011) Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society32(1):9-15 Key Points: Seventeen elite athletes with prodromal tendinous problems sustained an acute tear of the Achilles tendon and underwent percutaneous surgical repair. All patients were able to fully weight-bear on the operated limb by the end of the 8th postoperative week. The average time to return to full sport participation was 4.8±0.9 months.

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications 

Chen, Tony M.; Rozen, Warren M.; Pan, Wei-ren; Ashton, Mark W.; Richardson, Martin D.; Taylor, G. Ian. (2009) Clinical Anatomy vol. 22 issue 3, 377–385. Key Points: a) Blood is supplied to the midsection of the Achilles by the peroneal artery, and to the proximal and distal sections supplied by the posterior tibial artery; b) the midsection is markedly more hypovascular, and has the highest risk of rupture and surgical complications, c) Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and d) tendon operations should consider the blood supply route from the peroneal artery.

Cyclic Loading of 3 Achilles Tendon Repairs Simulating Early Postoperative Forces 

Lee, Steven J.; Sileo, Michael J.; Kremenic, Ian J.; Orishimo, Karl; Ben-Avi, Simon; Nicholas, Stephen J.; McHugh, Malachy (2009) American Journal of Sports Medicine vol. 37 no. 4 786-790 Key Point: Epitendinous cross-stitch weave augmentation of Achilles tendon repairs significantly increased repair strength and gap resistance.

Achilles tendon rupture repair: biomechanical comparison of the triple bundle technique versus the Krakow locking loop technique.

Jaakkola, JI; Hutton, WC; Beskin, JL; Lee, GP. (2000) Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society Jan; 21(1):14-7. Key Point: There is a statistically significant superiority of 2.8 to 1 (p < 0.001) in favor of the triple bundle technique.

Post Surgery Treatment and Non-Surgical Treatment of Achilles Tendon Rupture

For a summary see: Treating Achilles Tendon Injuries

Extracorporeal shockwave therapy in musculoskeletal disorders

Wang, Ching-Jen (2012) Journal of Orthopaedic Surgery and Research 7:11 Key Points: “ESWT is a new non-invasive therapeutic modality with effectiveness, convenience and safety. ESWT has the potential of replacing surgery in many orthopedic disorders without the surgical risks. The complication rates are low and negligible. The exact mechanism of shockwave therapy remains unknown.”

Ultrasonic assessment of extracellular matrix content in healing Achilles tendon

Ghorayeb, S.R.; Shah, N.V.; Edobor-Osula, F.; Lane, L.B.; Razzano, P.; Chahine, N.; Grande, D.A. (2012) IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control vol. 59 issue: pages: 694 – 702 Key Point: Ultrasound can be an effective imaging technique in assessing the degree of tendon healing, and can be used to correlate structural properties of Achilles tendons.

Weight Bearing in the Non-Operative Treatment of Acute Achilles Tendon Ruptures: A Randomised Controlled Trial

van Dijck, S., Young, S., Patel, A., Zhu, M., Bevan, W., Tomlinson, M. (2012) Journal of Bone & Joint Surgery British Edition vol. 94-B no. suppl. XLI 96 Key Points: Weight-bearing casts in the non-operative treatment of Achilles tendon ruptures appear to offer outcomes that are at least equivalent to outcomes of non-weight bearing casts. The overall re-rupture rate in this study is low, supporting the continued use of initial non-operative management in the treatment of acute ruptures.

Changes in blood circulation of the contralateral Achilles tendon during and after acupuncture and heating

Kubo, K.; Yajima, H.; Takayama, M.; Ikebukuro, T.; Mizoguchi, H; Takakura, N. (2011) International Journal of Sports Medicine 32(10):807-813. Key Point: Blood circulation in the injured tendon in a plaster cast may be improved by applying acupuncture or heating treatments to the contralateral healthy limb.

Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures – A Randomized Single-Blind Study

Schepull, Thorsten; Kvist, Joanna; Norrman, Hanna; Trinks, Marie; Berlin, Gösta; Aspenberg, Per (2011) American Journal of Sports Medicine vol. 39 no. 1 38-47. Key Point: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures.

Accelerated Achilles tendon healing by PDGF gene delivery with mesoporous silica nanoparticles

Suwalski, Arnaud; Dabboue, Hinda; Delalande, Anthony; Bensamoun, Sabine F.; Canon, Francis; Midoux, Patrick; Saillant, Gérard; Klatzmann, David; Salvetat, Jean-Paul; Pichon, Chantal. (2010) Biomaterials vol. 31 issue 19, 5237–5245 Key Point: Tendons treated with MSN and PDGF gene healed significantly faster than untreated tendons and those treated with pPDGF alone.

Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast

Kerkhoffs, G.M.M.J; Struijs, P.A.A; Raaymakers, E.L.F.B; Marti, R.K. (2002) Archives of Orthopaedic and Trauma Surgery 122: 102-105 Key Points: Functional treatment after surgical Achilles tendon repair is safe, and there is no increased risk of re-rupture or wound healing problems. Functional treatment with a wrap is preferable to treatment with a walking cast with respect to hospitalization time and return to sports.

General Achilles Tendon Rupture Research

For summaries, see Achilles Tendon Injury Overview and Achilles Tendon Physiology

Mechanical properties of the human Achilles tendon, in vivo

Kongsgaarda, M.; Nielsena, C.H.; Hegnsvada, S.; Aagaardb, P.; Magnussona, S.P. (2011) Clinical Biomechanics vol. 26 issue 7, August, Pages 772–777 Key Point: Ultrasonography is applicable for evaluation of free human Achilles tendon mechanical properties in relation to training, injury and rehabilitation.

Achilles Tendon Rupture – A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention

Hess, Gregory William (2009) Foot & Ankle Specialist vol. 3 no. 1 29-32. Key Points: a) A 2 in 100 000 individual Achilles tendon injury rate increased to a 12 in 100 000 in less than 10 years, b) Natural aging allows predisposing chronic degeneration of the tendon, c) Blood flow decreases and stiffness increases with aging to decrease the ability to withstand stress, d) Regular physical activity as athletes age promotes tendon hypertrophy, increases nutrient delivery, and reduces collagen fiber fatigue.

Light microscopic histology of Achilles tendon ruptures

Maffulli, N., Barrass, V., Ewen, S.W.B. (2000) American Journal of Sports Medicine 28, 857–63 Key point: the same degeneration that is present in tendons with Achilles tendinosis is also present in Achilles tendons that rupture.

The effect of foot structure and range of motion on musculoskeletal overuse injuries

Kaufman, K.R., Brodine, S.K., Shaffer, R.A., Johnson, C.W., Cullison, T.R. (1999) American Journal of Sports Medicine 27, 585–93 Key point: injury can be caused by tight inflexible calf muscles, and either hyper mobile flat feet or high arched cavus chunk feet.

Range of motion, muscle torque and training habits in runners with and without Achilles tendon problems

Haglund-Åkerlind, Y., Eriksson, E. (1993) Knee Surgery, Sports Traumatology and Arthroscopy 1, 195–99. Key points: a) runners with Achilles tendon injures have usually trained for significantly more years and run significantly more distance per week than runners without Achilles tendon injuries, and b) the calf muscles of runners with Achilles tendon injuries have significantly less eccentric strength than do those of uninjured runners.

Genes and Achilles Tendon Rupture

For additional causes of Achilles Tendon Rupture see: Causes of Achilles Tendon Injury

Genetic associations with Achilles tendinopathy

Scott, Alexander; Khan, Karim. (2010) Rheumatology 49 (11): 2005-2006 Key Point: individuals who carry a particular single nuclear polymorphism (SNP; specifically, the TT genotype of the GDF5 rs143383 variant) have twice the risk of developing Achilles tendon pathology compared with non-carriers.

Fluroquinolones, Quinolones and Achilles Tendon Rupture

For additional causes of Achilles Tendon Rupture see: Causes of Achilles Tendon Injury

Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study

Sode, Jacob; Obel, Niels; Hallas, Jesper; Lassen; Annmarie. (2007) European Journal of Clinical Pharmacology vol. 63 issue 5 p 499-503. Key Point: Fluoroquinolone use triples the risk of Achilles tendon rupture, but the incidence among users is low.

Increased Risk of Achilles Tendon Rupture With Quinolone Antibacterial Use, Especially in Elderly Patients Taking Oral Corticosteroids

van der Linden, Paul D.; Sturkenboom, Miriam C. J. M.; Herings, Ron M. C.; Leufkens, Hubert M. G.; Rowlands, Sam; Stricker, Bruno H. Ch. (2003) JAMA Internal Medicine vol 163 no.15 Key Point: Current exposure to quinolones increased the risk of Achilles tendon rupture. The risk is highest among elderly patients who were concomitantly treated with corticosteroids.

Cortisone and Achilles Tendon Rupture

See: Causes of Achilles Tendon Injury

Achilles tendonitis: Are corticosteroid injections useful or harmful?

Shrier, I., Matheson, G.O., Kohl, H.W. (1996). Clinical Journal of Sports Medicine 6, 245–50 Key points: a) there is no evidence to suggest that cortisone injections help with the treating the Achilles tendon, and b) the hypothesis that cortisone injections make a tendon more likely to rupture has not yet been confirmed in a study on humans.

Injections for tendon injuries: Cure or Cause

Ryan, A.J. (1978) Physician and Sportsmedicine 6 (September), 39. Key point: Cortisone injections may make a tendon more likely to rupture.

Barefoot Running and Achilles Tendon Rupture

For context, see: Footwear and Achilles Tendons

Barefoot Running Claims and Controversies – A Review of the Literature

Jenkins, David W.; Cauthon, David J. (2011) Journal of the American Podiatric Medical Association vol 101 no. 3 231-246. Key Points: Although there is no evidence that either confirms or refutes improved performance and reduced injuries in barefoot runners, many of the claimed disadvantages to barefoot running are not supported by the literature. Nonetheless, it seems that barefoot running may be an acceptable training method for athletes and coaches who understand and can minimize the risks.

Learn More