Kuwada classification of Achilles tendon tear

Last revised by Dr Daniel J Bell on 10 Nov 2021

The Kuwada classification of Achilles tendon tear was proposed in 1990 4 and remains the most widely used system for describing Achilles tendon rupture

Classification

Achilles tendon tears may be grouped (according to severity of the tear and degree of retraction) into four types:

  • type I: partial ruptures ≤50%
    • typically treated with conservative management
  • type II: complete rupture with tendinous gap ≤3 cm
    • typically treated with end-end anastomosis
  • type III: complete rupture with tendinous gap 3 to 6 cm
    • often requires tendon/synthetic graft
  • type IV: complete rupture with a defect of >6 cm (neglected ruptures)
    • often requires tendon/synthetic graft and gastrocnemius recession

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Cases and figures

  • Case 1: type II
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  • Case 2: type I
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  • Case 3: type III
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