If the lower re-rupture in operative treated patients was an effect of tendon-end apposition, then patients in whom that could be demonstrated in equinus by ultrasound could be equally well treated non-operatively without the attendant surgical risk.

All patients undergoing ultrasound for a suspected Achilles tendon repair between January 2000-2005 were included. Patients with a residual gap, 5mm or more in equinus; were treated by surgical repair. Those with a gap of less than 5mm were treated non-operatively. We excluded patients with no rupture, partial rupture and musculo-tendinuous junction (MTJ) tears. We recorded the following: clinical findings, ultrasound measurements of tendon gap in neutral and equinus, distance of rupture from distal insertion, the treatment and complications. All patients were followed up to a minimum of 6 months.

156 patients were treated for a clinical Achilles tendon rupture during the study period. We excluded 5 patients with no rupture on ultrasound, 15 with a MTJ tear, 7 with a muscle tear and 4 patients did not follow the protocol. 125 patients comprising 88 males and 37 females were entered into the study. 67 patients were treated operatively (37 open, 30 percutaneous) and 58 non-operatively. There was no significant difference between the 2 groups with respect to age, sex and injury mechanism. Two patients in the non-operative group had a re-rupture (3.4%) compared with 1 (1.5%) in the non-operative group. There were 2 incidences of superficial wound infection and 2 of temporary dorsal foot numbness in the operative. One patient in the non-operative group had a DVT. There was no significant difference for any of the complications between the two groups.

It may be possible to reduce the risk of re-rupture and surgery using dynamic ultrasound to determine which treatment the patient receives.