A 40-year-old runner presents with acute onset severe pain in the Achilles tendon while playing badminton, with an audible 'pop'. Simmonds-Thompson squeeze test is positive. Ultrasound confirms complete Achilles tendon rupture 4 cm above the insertion. The management that offers the lowest re-rupture rate with acceptable complication risk is:
- A Open surgical repair followed by early functional rehabilitation protocol ✓
- B Conservative management with plaster cast in equinus for 8 weeks, then functional rehabilitation
- C Percutaneous repair technique under ultrasound guidance
- D Immediate physiotherapy without immobilisation
Correct answer: A. Open surgical repair followed by early functional rehabilitation protocol
Explanation
Meta-analyses show open surgical repair has the lowest re-rupture rate (~3–5%) compared to conservative management (~10–15%), though surgery carries risks of wound complications and sural nerve injury. In active, young-to-middle-aged patients, surgical repair with early functional rehabilitation is recommended. Functional bracing (not rigid cast) has improved conservative outcomes, but re-rupture risk remains higher. Percutaneous repair reduces wound complications but is technically challenging and has intermediate re-rupture rates.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.