Operative versus nonoperative treatment of Achilles tendon rupture

Abstract

One hundred eleven patients with acute rupture of the Achilles tendon were included in a prospective trial and randomly assigned to groups for operative (56 patients) or nonoperative (55 patients) treatment. All of the patients were followed with clinic evaluations at 4 months and 1 year after the rupture. The major complications in the operative treatment group were three reruptures and two deep infections as compared with seven reruptures, one second rerupture, and one extreme residual lengthening of the tendon in the nonoperative group. There were fewer minor complications in the nonoperative group than in the operative group. The operatively treated patients had a significantly higher rate of resuming sports activities at the same level, a lesser degree of calf atrophy, better ankle movement, and fewer complaints 1 year after the accident. The conclusion we reached through this randomized prospective study is that operative treatment of ruptured Achilles tendons is preferable, but nonoperative treatment is an acceptable alternative.

Incidence of Achilles tendon rupture

“…The left tendon was ruptured more often than the right one, as in other reports (Hattrup and Johnson 1985, Jozsa et al 1989, Cetti et al 1993.…”

“…88% of the injuries occurred in ball games requiring sudden acceleration or jumping. Although there are national differences in the frequencies of different sports, ball games account for over 60% of the ruptures in many series (Nillius et al 1976, Inglis and Sculco 1981, Jozsa et al 1989, Leitner et al 1991, Cetti et al 1993). In our review of the literature football accounted for most of the AT ruptures in 13 of 40 articles and badminton in 12.…”

Results of surgical versus non-surgical treatment of Achilles tendon rupture

“…We found however only four randomised studies [1,16,17,22] (Table 3). Our retrospective study showed no significant differences in functional scores after surgical and non-surgical treatment.…”

“…Only four randomised studies exist, comparing nonsurgical and surgical treatment [1,16,17,22]. Two studies advocate the surgical approach, while two favour nonsurgical treatment.…”

Healing of subcutaneous tendons: Influence of the mechanical environment at the suture line on the healing process

“…Moreover, it is doubtless that we can attribute the noticed preservation of thigh and calf girths to our technique. The lack of tension on the immobilized musculotendinous unit is a major factor in the development of atrophy in the muscles [129,130] . This is due to the muscle spindle relaxing and afferent impulses to type-I fibers ceasing.…”