Management of Chronic Achilles Tendon Ruptures

Chronic Achilles tendon rupture is a difficult condition to treat due to tendon retraction and histologic changes. Traditional treatments include primary repair (for defects <2 cm), VY advancement (using gastrocnemius aponeurosis for larger gaps), Achilles tendon turndown (using gastrocnemius fascia, often with flexor hallucis longus transfer), allografts, and tendon transfers (using peroneus brevis or flexor hallucis longus tendons). New synthetic graft options, such as acellular collagen matrices and Artelon, may improve chronic Achilles tendon rupture healing without the morbidity associated with traditional techniques.