Bilateral Simultaneous Achilles Tendon Rupture in the Absence of Risk Factors

The Achilles tendon is the most frequently ruptured tendon in the lower limb and comprises approxi- mately 20% of all large tendon ruptures. Spontaneous rupture of the Achilles tendon is usually observed in healthy, active individuals in the third to fifth decades of life and is twice as common in males. It usually occurs following high-performance activities. The authors report a case of unusual presentation of bilateral simultaneous Achilles tendon ruptures that occurred following a low-effort-level sport and in the absence of risk factors. In the case presented, nonoperative treatment led to a successful outcome. 1 Spontaneous unilateral rupture of the Achilles tendon is usually observed in healthy, active individuals in the third to fifth decades of life follow- ing a high-performance sporting activ- ity. 2 Bilateral Achilles tendon ruptures are uncommon in the absence of risk factors or high-energy trauma. The reported incidence of complete Achilles ten- don rupture in the gen- eral population is about 0.02%. Less than 1% of these were reported to have bilateral Achilles ten- don ruptures. 3 Bilateral ruptures tend to occur in older patients with predis- posing risk factors and/ or chronic steroid usage. Multiple factors including the nature of the injury, patient comorbidity and expectations, surgeon preferences and experience, as well as available resources should be considered prior to committing patients to operative or nonoperative treatment modalities. We report a case of unusual presen- tation of bilateral simultaneous Achilles tendon ruptures that occurred following a low-effort-level sport and in the absence of risk factors and that were treated non- operatively with a successful outcome.