Saltzman and Tearse review the full spectrum of Achilles tendon injuries — from overuse paratenonitis to acute and neglected ruptures — covering anatomy, classification, diagnosis, imaging, and treatment. The central question: how should clinicians classify and manage Achilles pathology across its stages?
When evaluating any posterior ankle pain, use the three-stage histopathologic classification (paratenonitis → paratenonitis with tendinosis → tendinosis) to match treatment intensity to pathology — conservative care first for inflammatory stages, surgical debridement for refractory tendinosis.
For acute ruptures, counsel patients that surgery roughly halves rerupture risk, but a missed diagnosis rate of 23% means you must actively exclude rupture even when the Thompson test appears equivocal.
Saltzman and Tearse review the full spectrum of Achilles tendon injuries — from overuse paratenonitis to acute and neglected ruptures — covering anatomy, classification, diagnosis, imaging, and treatment. The central question: how should clinicians classify and manage Achilles pathology across its stages?
When evaluating any posterior ankle pain, use the three-stage histopathologic classification (paratenonitis → paratenonitis with tendinosis → tendinosis) to match treatment intensity to pathology — conservative care first for inflammatory stages, surgical debridement for refractory tendinosis.
For acute ruptures, counsel patients that surgery roughly halves rerupture risk, but a missed diagnosis rate of 23% means you must actively exclude rupture even when the Thompson test appears equivocal.