Achilles Tendon Rupture – To Operate or Not

Researchers in the BMJ note that the number of surgeries for these injuries has declined in recent years as a result of studies suggesting that operating might not be more effective than alternatives like a walking cast or physical therapy.

 

But Achilles tendon ruptures are also becoming more common, particularly among active middle-aged and older adults, leading some doctors and patients to question whether surgery might still be the best choice for preventing future injuries.

Researchers examined data from 29 studies with a total of almost 15,000 patients and found 2.3 percent of people treated with surgeries experienced another torn Achilles tendon after treatment, compared with 3.9 percent of those who opted for non-surgical approaches.

However, 4.9 percent of surgical patients experienced infections and other complications like blood clots, compared with just 1.6 percent of people who didn’t get surgery.

“These findings indicate that the benefits associated with operative treatment might not always exceed the harm and risk associated with surgical intervention,” said lead study author Yassine Ochen of University Medical Center Utrecht in the Netherlands.

Ochen said weighing the benefits and harms of surgery may come down to how active patients need to be after treatment, and how likely they are to play sports that increase the risk of repeat injuries. Athletic people may prefer operative treatment to enhance and expedite their outcomes, whereas a sedentary person with limited functional outcome expectations may prefer nonoperative treatment.

The aim of any treatment is to get the tendon ends together and keep them close to each other as they heal. With surgery, stitches in the tendon keep the ends together; nonsurgical treatments rely on the body’s natural healing ability and count on the tendon ends to remain close together and may use a cast or boot to restrict movements that could separate the ends.

With conservative management if the tendon ends are not kept together during treatment or if the tendon heals in a stretched manner, the strength of the calf muscles to “push off” during running and jumping will be considerably reduced and an active young person will find this as a handicap.

Only 10 of the smaller studies included in the analysis were controlled experiments designed to assess whether surgery might be safer or more effective than alternative treatments.

Another limitation of the review is that too few studies examined how long it took patients to return to work or playing sports, to determine whether there might be a meaningful difference between surgery and other treatments.

(The Study was published in 2019)

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