Achilles tendon rupture

The treatment of acute of Achilles tendon rupture experienced a dynamic dev elopment in the last ten years. Decisive for this development was the appli cation of MRI and above all the ultrasonography in the diagnostics of the p athological changes and injuries of tendons. The question of ruptue morphol ogy as well as different courses of healing could be now evaluated objectiv ely. These advances led consequently to new modalities in treatment concept s and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation perio d came with introduction of the early functional treatment in contrast to i mmobilizing plaster treatment. In a prospective randomized study (1987-1989 ) at the Trauma Dept. of the Hannover Medical School could show no statisti cal differences comparing functional non-operative with functional operativ e therapy with a special therapy boot (Variostabil/Adidas(R)). The crucial criteria for therapy selection results from the sonografically measured pos ition of the tendon stumps in plantar flexion (20 degrees). With complete a daptation of the tendons' ends surgical treatment does not achieve better r esults than non-operative functional treatment in term of tendon healing an d functional outcome. Regarding the current therapeutic standards each meth od has is advantages and disadvantages. Both, the operative and non-operati ve functional treatment enable a stable tendon healing with a low risk of r erupture (1-2 %). Meanwhile there is consensus for early functional after-t reatment of the operated Achilles' tendons. There seems to be a trend towar ds non-operative functional treatment in cases of adaquate sonografical fin dings, or to minimal invasive surgical techniques.