A 40-year-old man presents with inability to stand on tiptoe on the right side, a palpable gap 4 cm above the posterior heel, and a positive Thompson (Simmonds) test. Ultrasound confirms complete Achilles tendon rupture. The most appropriate management for an active young adult is:
- A Primary surgical repair (open end-to-end tendon suture) followed by functional rehabilitation ✓
- B Conservative management in an equinus plaster cast for 8 weeks
- C Immediate weight-bearing and physiotherapy
- D Percutaneous repair under ultrasound guidance
Correct answer: A. Primary surgical repair (open end-to-end tendon suture) followed by functional rehabilitation
Explanation
In young active adults, primary surgical repair of acute Achilles tendon rupture reduces the re-rupture rate (2–5% vs 8–12% with conservative treatment) and allows faster return to sport. Open repair with a Krackow or Bunnell type suture provides strong fixation. Conservative treatment (functional bracing in modern protocols) has comparable outcomes in sedentary patients or those at high surgical risk. Percutaneous repair is an intermediate option with lower wound complication rates but slightly higher re-rupture risk than open repair.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.