Choosing Wisely:

Avoid ordering MRI in patients with suspected acute Achilles tendon ruptures.

Rationale and Comments: MRI is expensive and can lead to treatment delays. History and physical exam findings can establish the diagnosis of acute Achilles tendon ruptures in nearly all instances. Physicians should reserve MRI for atypical presentations and subacute or neglected ruptures when preoperative planning is needed. When physicians prefer to use the rupture gap (i.e., apposition of tendon ends) as criteria for management (surgery versus conservative treatment), dynamic ultrasound can be easily substituted.
Sponsoring Organizations:
  • American Podiatric Medical Association
  • Sources:
  • Expert consensus
  • Disciplines:
  • Sports Medicine
  • Orthopedic
  • References: • Singh D. Acute Achilles tendon rupture. BMJ. 2015;351:h4722.
    • Garras DN, Raiken SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. 2012;470:2268-73.
    • Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br. 2011;93:1362–66.

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