[Achilles tendon rupture]

Whereas Achilles tendon rupture is usually treated operatively in central Europe, conservative treatment is felt to be indicated in Britain, North America and the Scandinavian countries. In a prospective randomized trial we compared conservative functional treatment and operative functional treatment with a newly developed boot. Forty-four patients (19 with operative, 25 with conservative treatment) were entered in the study. The initial evaluation included dynamic ultrasonography and MRI in a neutral position and at 20 degrees of plantar flexion to determine the amount of tendon diastasis. Follow-up clinical examination and ultrasonography revealed, no significant differences between the two groups. After 25 months all patients in both groups had complete healing with no rerupture. Functional treatment allows an earlier return to work and earlier resumption of active sport. We observed stable tendon healing, optimal functional results, and a high level of patient satisfaction. Primary functional treatment does not appear to be inferior to operative functional treatment when no more than 5 mm tendon diastasis is observed on the initial ultrasonography in the neutral position.