Achilles Tendon Rupture: Surgery vs. Conservative Care

Reference:Soroceanu A, et al. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012 Dec 5;94(23):2136-43.

A patient reports while playing squash, they heard a loud “pop” in their heel and they could not walk afterwards. Upon assessment you note major loss of plantar flexor strength and severe tenderness in the Achilles tendon.

The ultrasound and MRI show the patient has an Achilles tendon rupture. Now the patient asks you, “Should I get surgery or just cast it?”

What should be your evidence-based answer?

The latest meta-analysis (involving the 10 best RCTs) on this topic showed the following 4 results.

1. If functional rehab with early ROM was provided, re-rupture rates were equal for surgical and nonsurgical patients.

2. Surgery was associated with an absolute risk increase of 16% in favor of non-operative management for complications (other than re-rupture.)

3. Surgical patients returned to work on average 19 days sooner.

4. There was no significant difference between the two treatments with regard to calf strength, circumference, or function in the long term.

Let us get back to the patient’s question: “Should I get surgery for my Achilles tendon rupture?”

Evidence-based answer: If you get good rehab / physio, there is no need for surgery as all long term outcomes are the same, except the risk of complication is significantly more with surgery.

If you are not willing to get good physio or don’t have access to one, then go for surgery as your return to function is faster by 2-3 weeks and recurrence rate is slightly less.

Posted on: July 04, 2013

Categories: Foot & Ankle

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