Achilles Injuries in the Athlete: Noninsertional

Achilles tendinopathy is common in both athletic and nonathletic individuals, and the incidence has risen in the last few decades. Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its cause, pathology, natural history, and optimal management. The treatment of Achilles tendinopathy lacks evidence-based support, and individuals having tendinopathy are at risk of long-term morbidity with unpredictable clinical outcome. Most patients respond to conservative treatments. When conservative management is unsuccessful, surgery is recommended. Similar results have been reported with both open and minimally invasive techniques. However, minimally invasive techniques appear to reduce the risks of infection and provide better cosmetic results. An Achilles tendon rupture is frequent in young athletes and middle-aged people who practice recreational activities, and it is a serious injury. The management should take into account the age, occupation, and level of sporting activity. Open surgery provides good functional results and a lower rerupture rate, but it is frequently associated with a higher risk of superficial skin breakdown and wound problems. Percutaneous repair aims to provide good functional outcome while decreasing the problems associated with open surgery for wound healing and skin breakdown. Percutaneous repair followed by early functional rehabilitation is becoming increasingly common and should be considered in selected patients.