Achilles tendon rupture- is surgery ALWAYS indicated?

It can be a scary thing when you rupture your Achilles tendon! Yes recovery can be a long process, but virtually full recovery is possible in many case. The interesting thing that many don’t realize however is that OFTEN rehab is just as good as surgery– which is something this 2019 review study looked at.

Objective

The aim of this systematic review and meta-analysis was to compare operative and nonoperative treatments for acute Achilles tendon rupture. The authors focused on differences in tendon re-rupture rates, complication rates, return to work, and functional recovery between treatment approaches.

Study Design

The authors searched several medical databases to identify randomized controlled trials comparing surgical and nonoperative management of acute Achilles tendon rupture.

• Fourteen randomized controlled trials were included, representing a total of 1,628 patients.
• The average follow-up period across studies ranged from 6 months to over 2 years.
• Outcomes analyzed included re-rupture rates, overall complication rates, Achilles Tendon Total Rupture Score (ATRS), ankle range of motion, and time to return to work.

This was a well designed study!

Results

• The overall re-rupture rate was significantly lower in the open surgical group compared to the nonoperative group, with re-rupture occurring in approximately 1 to 3 percent of surgically treated patients versus about 6 to 12 percent of nonoperatively treated patients.
• Minimally invasive surgical repair also showed a lower re-rupture rate than nonoperative treatment, with re-rupture rates closer to those seen with open surgery.
• Open surgical repair was associated with a higher rate of complications, with overall complication rates reported between 10 and 20 percent, including wound infection, delayed healing, and nerve injury.
• Nonoperative treatment showed lower rates of these surgical complications, generally below 5 percent.
• Minimally invasive surgery demonstrated complication rates similar to nonoperative treatment and lower than open surgery.
• Functional outcomes, including ATRS scores, showed no statistically significant difference between operative and nonoperative groups at final follow-up, with most studies reporting ATRS scores in the range of 80 to 90 points for both groups.
• Measures of ankle range of motion and calf strength were also similar between groups.
• Patients treated with minimally invasive surgery returned to work earlier, on average 1 to 3 weeks sooner, compared to those treated nonoperatively.

How does this apply to you?

This review found that surgical treatment of acute Achilles tendon rupture reduces the risk of tendon re-rupture compared with nonoperative management but increases the risk of complications, particularly with open surgery. Minimally invasive surgical techniques appear to balance lower re-rupture rates with fewer complications and may allow an earlier return to work.

That being said, long-term functional outcomes were similar between surgical and nonoperative treatments, suggesting that both approaches can lead to comparable recovery when appropriate rehabilitation is provided.

So this isn’t a one-option fits all treatment. Do you have a daily life that puts you at risk for re-rupture? Do you have a less active/ risky lifestyle with a high need to get back to work ASAP? These are the types of questions you want to ask yourself when making the choice that’s right for you.

If you have more questions or you want to book with one of our physiotherapists based in Waterloo, you can do so HERE.