Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis

J Emerg Med. 2021 Nov;61(5):558-567. doi: 10.1016/j.jemermed.2021.09.008. Epub 2021 Nov 17.


Background: Achilles tendon rupture is a common injury with increasing incidence due to the rising popularity of high-velocity sports, continued physical activity of the aging American population, and use of fluoroquinolones and steroid injections. The diagnosis can often be missed or delayed, with up to 20% misdiagnosed, most commonly as an ankle sprain.

Objective: The aim of our study was to systematically evaluate the reported sensitivity, specificity, and likelihood ratios of ultrasound for detecting Achilles tendon rupture in patients who were treated surgically.

Methods: In January 2020, we performed a literature search of MEDLINE and EMBASE databases to identify eligible articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were original studies with at least five patients, which reported data on the sonographic diagnosis of Achilles tendon rupture (complete or partial) compared to surgery as the reference standard.

Results: A total of 15 studies with 808 patients were included in the primary analysis. The sensitivity of ultrasound for detecting complete Achilles tendon ruptures was 94.8% (95% confidence interval [CI] 91.3-97.2%), specificity was 98.7% (95% CI 97.0-99.6%), positive likelihood ratio was 74.0 (95% CI 31.0-176.8), and negative likelihood ratio was 0.05 (95% CI 0.03-0.09), in patients who underwent surgical treatment.

Conclusions: The results from our study suggested that a negative ultrasound result may have the potential to rule out a complete, as well as a partial, Achilles tendon rupture.

Keywords: Achilles tendon; POCUS; point-of-care ultrasound; sonogram; sonographic; tendon injury; tendon rupture; tendon tear; ultrasound.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Achilles Tendon* / diagnostic imaging
  • Achilles Tendon* / surgery
  • Ankle Injuries*
  • Humans
  • Rupture / surgery
  • Tendon Injuries* / diagnostic imaging
  • Tendon Injuries* / surgery
  • Ultrasonography