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Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

Feng, Shi-Ming; Maffulli, Nicola; Oliva, Francesco; Saxena, Amol; Hao, Yue-Feng; Hua, Ying-Hui; Xu, Hai-Lin; Tao, Xu; Xu, Wei; Migliorini, Filippo; Ma, Chao


Shi-Ming Feng

Nicola Maffulli

Francesco Oliva

Amol Saxena

Yue-Feng Hao

Ying-Hui Hua

Hai-Lin Xu

Xu Tao

Wei Xu

Filippo Migliorini

Chao Ma


Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes.

A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines.

Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol.

Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.


Feng, S., Maffulli, N., Oliva, F., Saxena, A., Hao, Y., Hua, Y., …Ma, C. (in press). Surgical management of chronic Achilles tendon rupture: evidence-based guidelines. Journal of Orthopaedic Surgery and Research, 19(1), Article 132.

Journal Article Type Article
Acceptance Date Jan 11, 2024
Online Publication Date Feb 10, 2024
Deposit Date Feb 19, 2024
Journal Journal of Orthopaedic Surgery and Research
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Issue 1
Article Number 132
Keywords Surgical management, Guidelines, Chronic Achilles tendon rupture
Publisher URL