Controversies in Treatment of Achilles Tendon Ruptures

Achilles tendon ruptures are very common sports injuries.   Many years ago, these were treated without surgery, but muscular weakness and a high risk of re-rupture were common problems.  Over the past 10-15 years, the majority of orthopedists have advocated repair.  Repair clearly decreases the risk of re-rupture, but muscular weakness remains an issue, and there are risks of infection, wound healing complications, and nerve damage.

In the past few years, the controversy as to whether surgical or nonsurgical treatment is preferred has resurfaced.  Some recent studies suggest that when the same accelerated rehab program is used, the outcomes for surgery or nonoperative treatment are much more similar than in the “old days”.  We used to immobilize patients longer in a boot or cast, whether or not we did surgery.  Accelerated rehab somewhat decreases the difference in outcomes, but there is still a somewhat higher risk of re-rupture and more muscular weakness without surgery.

This article  found that nonsurgical treatment of achilles tendon ruptures results in significantly more chronic muscular atrophy than surgery.  In addition, without surgery, the tendon heals nearly 2cm longer (stretched).  I’ve always been a strong proponent of surgical repair for achilles tendon rupture.  The study I’ve cited here is just one data point, but in combination with the well established body of research and my own clinical experience, it strongly reinforces my recommendation for surgical repair of these injuries for the vast majority of my patients.