A comprehensive review of surgical techniques for chronic Achilles tendon rupture

Chronic Achilles tendon rupture (CATR) represents a significant clinical challenge, often necessitating surgical intervention to restore function, alleviate pain, and prevent long-term complications. The complex nature of CATR, characterized by tendon retraction, scar formation, and poor tissue quality, requires a tailored, evidence-based approach. This review comprehensively examines current surgical strategies for managing CATR, focusing on their indications, advantages, outcomes, and associated complications. A detailed literature search of 20 studies published between 2010 and 2023 identified key surgical techniques, including end-to-end repair, tendon transfers, autografts, synthetic grafts, and allografts. Surgical recommendations were stratified by defect size and patient factors. Small defects (<2 cm) are effectively managed with end-to-end repair or tendon transfers, offering rapid recovery and restoration of tendon continuity. Medium defects (2-5 cm) benefit from techniques such as V-Y plasty or semitendinosus autografts, providing additional length and biomechanical stability. Larger defects (>5 cm) often necessitate advanced procedures, including free tendon grafts, synthetic materials, or allografts, particularly for older patients or those with poor tissue quality. Minimally invasive techniques, such as endoscopic flexor hallucis longus transfer, have shown promise in reducing recovery times and complications. A structured decision-making framework is proposed to guide surgical choices, ensuring patient-specific, optimal outcomes. Emerging techniques further expand the possibilities for managing this challenging condition, emphasizing the need for innovation and individualized care in CATR treatment.