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Achilles Tendon Ruptures: Nonsurgical Versus Surgical Treatment.

Rachit Saggar1, Joseph Mullen1, Peter G Mangone1

  • 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
|May 2, 2025
PubMed
Summary

Achilles tendon rupture treatment involves surgery or nonsurgical options. Surgery lowers re-rupture risk but increases complications, while nonsurgical methods offer comparable outcomes for selected patients. Patient-centered care guides optimal choice.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Surgical Innovation

Background:

  • Achilles tendon ruptures are common in active adults, necessitating a choice between surgical repair and nonsurgical management.
  • Treatment decisions involve balancing rerupture rates, return-to-work timelines, and potential surgical complications.
  • Minimally invasive surgical techniques offer an alternative to open repair, with distinct risk-benefit profiles.

Purpose of the Study:

  • To compare the efficacy and safety of surgical (open and minimally invasive) versus nonsurgical management for Achilles tendon ruptures.
  • To evaluate functional outcomes, complication rates, and cost-effectiveness of different treatment modalities.
  • To inform patient-centered care strategies and shared decision-making in Achilles tendon rupture treatment.

Main Methods:

  • Meta-analyses comparing surgical and nonsurgical treatments for Achilles tendon ruptures.
  • Review of clinical trials, including the UKSTAR trial, assessing functional bracing versus plaster casting.
  • Analysis of complication rates (infections, nerve injuries, DVT) and functional outcome scores (e.g., Achilles Tendon Rupture Score).

Main Results:

  • Surgery significantly reduces rerupture risk but increases overall complication rates compared to nonsurgical management.
  • Minimally invasive surgery shows comparable outcomes to open repair with fewer superficial infections but a higher risk of sural nerve injury.
  • Nonsurgical management and early weightbearing protocols yield comparable functional outcomes in selected patients, with functional bracing proving effective.
  • Surgical patients exhibit faster strength recovery, but nonsurgical management may lower indirect costs due to reduced complications.

Conclusions:

  • Treatment choice for Achilles tendon ruptures should be individualized, considering patient age, activity level, comorbidities, and goals.
  • Shared decision-making is crucial for optimizing patient satisfaction and aligning treatment with functional requirements.
  • Early mobilization and rehabilitation are vital for successful outcomes in both surgical and nonsurgical Achilles tendon rupture management.