Revision Surgery for Achilles Tendon Rupture: A Comprehensive Review of Treatment Options, Outcomes, and Complications and the Role of Artificial Intelligence

Background and Objectives: Achilles tendon ruptures in middle-aged individuals with systemic comorbidities represent a growing clinical challenge. Revision surgery, indicated in cases of tendon re-rupture, remains technically demanding and lacks standardized treatment protocols. This comprehensive review aimed to summarize current evidence regarding indications, outcomes, and complications associated with the most commonly employed revision techniques and explores the potential of artificial intelligence (AI) in improving management and outcomes. Materials and Methods: A literature review was performed in accordance with PRISMA guidelines. The PubMed, MEDLINE, and Cochrane Central databases were used to search keywords. We included articles (1) reporting indications, outcomes, and/or complications of revision surgery for Achilles tendon rupture; (2) reporting a minimum mean follow-up of >12 months; and (3) written in English. Six studies met the inclusion criteria, with a total of 3250 patients analyzed. A methodological quality assessment using the Modified Newcastle-Ottawa Quality Assessment Scale was performed, and all articles were found to be of high quality. Results: Surgical strategies were stratified based on defect size: <2 cm: end-to-end anastomosis; 2-5 cm: V-Y myotendinous lengthening, often combined with tendon transfer; and >5 cm: fascial turndown flaps, autografts (e.g., semitendinosus), or allografts. Tendon transfers showed satisfactory functional outcomes but varied in complication rates. Allografts offered reduced donor site morbidity. The use of AI and wearable sensors has demonstrated potential in preoperative planning, complication prediction, and real-time rehabilitation monitoring. Conclusions: Achilles tendon revision surgery requires a patient-specific, defect-oriented approach. Combined surgical techniques are often necessary for large or non-viable lesions. The integration of AI represents a promising advancement in enhancing surgical decision-making, optimizing rehabilitation, and improving long-term clinical outcomes.