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Achilles tendon rupture: Conservative Vs surgical management

The Achilles tendon is the strongest in the body, but is frequently injured in mainly the young to middle aged active population. The older generation do suffer with Achilles tendon rupture, and males are more likely to sustain injury.

Management strategies for Achilles tendon rupture is still under debate, and clarity is needed to ascertain whether a surgical or conservative approach is recommended. The rate of re-rupture is a key indicator of success, as well as restoring function to the former level and self-satisfaction from patients.

A meta-analysis of randomised controlled trials conducted by She, G., et al. (2021) found that surgical treatment had a lower re-rupture rate, and there appeared to be little benefit to early rehabilitation on functional recovery. There was no difference between groups in the time taken to return to sport. Conversely, conservative treatment was associated with a lower complication rate.

It was stated that treatment should be focused on optimal functional recovery, with reduced possibilities of complications. Conservative treatment allowed earlier weightbearing, which in turn stimulates collagen production and faster healing.

Potential complications with surgical intervention include deep vein thrombosis (0.3-50%), wound infection (2.2-5.8%), and nerve injury (7.8%). The purpose of the study was to weigh up the risk, to the benefit of surgery. Conservative treatment was found to be capable of having similar functional outcomes with surgical treatment.

She, G., et al. (2021). Comparing surgical and conservative treatment on Achilles tendon rupture: A comparative meta-analysis of RCTs. Front. Surg.


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