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  Achilles tendon rupture is a common sports-­related injury in patients in their 40s and 50s
  
  
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  Examination
  

  
  
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    Palpable gap in midsubstance of tendon
    
    
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    Thompson test shows no plantar flexion when calf is squeezed
  
  
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  Recent data show comparable outcomes with surgical and nonsurgical treatment
  
  
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  Historically, acute surgical repair was normal course of treatment
  
  
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  Patients who benefit from nonsurgical treatment include those with diabetes, neuropathy, immunocompromised states, peripheral vascular disease, and systemic dermatologic diseases as well as those who are older than 65 years, who smoke, who are sedentary, or who have obesity
  
  
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  Reduced risk for rerupture is biggest benefit of repair
  
  
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  Treatment options—Open, limited open, or percutaneous

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  Prone position or supine with bump under contralateral hip to access medial heel in figure-­of-­4 position
  
  
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  Make incision midline or just medial to midline. Avoids watershed area
  
  
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  Débride string-­like tissue at the ends of the tendons
  
  
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  For repair, author prefers Krackow stitch with No. 2 nonabsorbable suture (Figure 1)
  
  
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  After repair, gentle range to position of maximum dorsiflexion to determine stability of repair
  
  
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  Consider a drain for postoperative hematoma control
  
  
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  Maintain meticulous closure, because wound breakdown is biggest complication
  
  
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  Immobilize in 5° to 10° equinus

Chronic or Neglected Achilles Tendon Rupture

Surgical Planning