Open Access Publication

Background: Achilles tendon rupture is a common injury, which can frequently affect young, active people. Consequently, there are important socio-economic implications in choosing the correct treatment. There is considerable debate in the literature concerning surgical versus non-surgical treatment and most surgeons would elect not to repair a rupture within the muscle belly above the musculotendinous junction. There is a wide anatomical variation in the exact location of the Achilles musculotendinous junction, which can lead to confusion among surgeons when trying to identify the location of a rupture and treatment plan. Materials and Methods: Delegates at a regional orthopaedic meeting were asked to fill in a questionnaire, which showed a photograph of a lower limb. They were asked to draw two transverse lines, the first identifying the musculotendinous junction, and the second marking the highest level at which they would consider a surgical repair. They were asked about their understanding of the term “musculotendinous junction”. Results: Twenty two delegates (n =22) of various degrees of seniority responded. There was a wide variety of answers, with the average level of the musculotendinous junction identified as being 10.1cm above the insertion into the calcaneum. The average highest level for considering surgical intervention was 8.71cm above the insertion into the calcaneum. Cadaveric measurements have shown that in fact the Achilles musculotendinous junction lies on average 5.51cm above the tendons attachment to the calcaneum. Conclusion: There is confusion regarding the exact location and nature of the Achilles musculotendinous junction among the orthopaedic surgeons in our survey. Although most surgeons stated that they would not operate on a rupture above the musculotendinous junction, almost all identified a point higher than this region as their highest point for repair. Particular care is advised if an ultrasound reports the location of any rupture relative to the musculotendinous junction.