Management and Outcomes of Achilles Tendon Re-rupture: A Retrospective Cohort Study
- 1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
- 2Princeton University, NJ, USA
Abstract
Background:: Achilles tendon re-rupture is a challenging complication with limited data guiding optimal management. The purpose of this study was to evaluate treatment strategies, patient characteristics, and outcomes of Achilles tendon re-ruptures in an academic large single institution series.
Methods:: A retrospective review was done of acute Achilles tendon re-ruptures (2015-2025). Index ruptures and re-ruptures were confirmed by clinical examination and a positive Thompson test. Minimum clinical follow-up was 3 months. Clinical outcomes included reoperation rates and return to normal activity. Patient-reported outcomes were collected at a minimum of 1 year post–secondary repair and included visual analog scale (VAS; n = 32) and Foot and Ankle Ability Measure (FAAM-ADL; n = 15) scores.
Results:: Forty-one re-ruptures were identified with a mean follow-up of 22.4 months. Mean age at re-rupture was 43.6 years (82.9% male; body mass index 29.8). Index ruptures were primarily treated operatively (65.9%) at a median of 4 days post-injury. Re-ruptures occurred at a median of 96 days (IQR 53.5-136), most commonly because of falls (47.5%) and at the midsubstance area of the tendon (70.7%). Most re-ruptures were treated operatively (82.9%) with flexor hallucis longus transfer (52.9%). In surgically treated re-ruptures (n = 34), wound dehiscence occurred in 7 patients (20.6%). Six of 7 wound dehiscence cases had their index rupture treated surgically. Mean FAAM-ADL was 90.1 and VAS was 1.39. Operative treatment of the re-rupture was associated with a higher rate of return to normal activity “operative 73.5% vs nonoperative 14.3%” (P = .006).
Conclusion:: Achilles tendon re-ruptures most commonly occurred 3 months from initial treatment and were predominantly managed surgically. Operative treatment was associated with higher rates of return to normal activity, but carried a substantial risk of wound complications, with a higher unadjusted rate among patients with a history of prior operative repair that did not remain significant after adjustment.
Level of Evidence:: Level III, retrospective cohort study.
Related
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BibTeX
@article{thomas2026management,
title = {{Management and Outcomes of Achilles Tendon Re-rupture: A Retrospective Cohort Study}},
author = {Grant M. Thomas and Lauren O’Mara and Kush Mody and Andre Pagliaro and Selene G. Parekh and Anny Hsu},
journal = {Foot \& ankle orthopaedics},
year = {2026},
month = jul,
doi = {10.1177/24730114261486739},
url = {https://europepmc.org/article/PMC/PMC13724933},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Management and Outcomes of Achilles Tendon Re-rupture: A Retrospective Cohort Study
AU - Grant M. Thomas
AU - Lauren O’Mara
AU - Kush Mody
AU - Andre Pagliaro
AU - Selene G. Parekh
AU - Anny Hsu
PY - 2026
DA - 2026/07/01
JO - Foot & ankle orthopaedics
DO - 10.1177/24730114261486739
UR - https://europepmc.org/article/PMC/PMC13724933
AB - Background:: Achilles tendon re-rupture is a challenging complication with limited data guiding optimal management. The purpose of this study was to evaluate treatment strategies, patient characteristics, and outcomes of Achilles tendon re-ruptures in an academic large single institution series. Methods:: A retrospective review was done of acute Achilles tendon re-ruptures (2015-2025). Index ruptures and re-ruptures were confirmed by clinical examination and a positive Thompson test. Minimum clinical follow-up was 3 months. Clinical outcomes included reoperation rates and return to normal activity. Patient-reported outcomes were collected at a minimum of 1 year post–secondary repair and included visual analog scale (VAS; n = 32) and Foot and Ankle Ability Measure (FAAM-ADL; n = 15) scores. Results:: Forty-one re-ruptures were identified with a mean follow-up of 22.4 months. Mean age at re-rupture was 43.6 years (82.9% male; body mass index 29.8). Index ruptures were primarily treated operatively (65.9%) at a median of 4 days post-injury. Re-ruptures occurred at a median of 96 days (IQR 53.5-136), most commonly because of falls (47.5%) and at the midsubstance area of the tendon (70.7%). Most re-ruptures were treated operatively (82.9%) with flexor hallucis longus transfer (52.9%). In surgically treated re-ruptures (n = 34), wound dehiscence occurred in 7 patients (20.6%). Six of 7 wound dehiscence cases had their index rupture treated surgically. Mean FAAM-ADL was 90.1 and VAS was 1.39. Operative treatment of the re-rupture was associated with a higher rate of return to normal activity “operative 73.5% vs nonoperative 14.3%” (P = .006). Conclusion:: Achilles tendon re-ruptures most commonly occurred 3 months from initial treatment and were predominantly managed surgically. Operative treatment was associated with higher rates of return to normal activity, but carried a substantial risk of wound complications, with a higher unadjusted rate among patients with a history of prior operative repair that did not remain significant after adjustment. Level of Evidence:: Level III, retrospective cohort study.
SN - 2473-0114
ER -