Incidence Rate of Re-Rupture after Surgical Repair of the Achilles Tendon

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The Achilles tendon is the largest and one of the most commonly ruptured tendons in the human body. While debate surrounds the most effective treatment for these ruptures—operative or non-operative care—the risk of tendon re-rupture remains a concern for patients and physicians alike. Literature shows the rate of re-rupture after surgical treatment to be 2-7%.1,2 This study seeks to report the incidence of re-rupture after an acute primary surgical repair of an Achilles tendon rupture. Methods: A retrospective chart review was completed to identify primary Achilles tendon ruptures patients who encountered a subsequent re-rupture. The dates of surgery were from January 2014 to December 2023 at a single institution. Both open and minimally invasive (MIS) surgical repairs were included. Re-ruptures were delineated by whether the patient received operative or non-operative treatment. Patient demographics and comorbidities were collected along with surgical data including primary and re-rupture repair surgical technique, repair suture used, use of flexor hallucis longus (FHL) or graft, and skin closure technique. The mechanism of re-rupture and time between primary was also documented. Results: 1692 primary Achilles repair procedures with 1665 patients were reviewed for a re-rupture. 87% were male and the average age was 43.5 (9.1-85.9) years old. The rate of re-rupture was 1.6% (27 patients, 27 Achilles), including 1.4% receiving operative treatment, and 0.2% receiving non-operative treatment. The average time to re-operation was 3.0 months. All patients received an open primary repair, with none receiving a minimally invasive primary repair. Conclusion: This large patient cohort at a single institution shows that the incidence rate of re-rupture after a primary surgical repair of the Achilles tendon is lower than previously reported in literature.