What is the comparison of recurrence rates between patients with Achilles tendon rupture who undergo surgical repair and those who opt for non-surgical management?

From the Guidelines

Patients with Achilles tendon rupture who undergo surgical repair have significantly lower recurrence rates compared to those who opt for non-surgical management, with re-rupture rates of approximately 3-5% versus 10-12%, respectively. This is based on the findings of a study published in The Journal of the American Academy of Orthopaedic Surgeons in 2010 1, which reported that patients treated surgically had significantly fewer reruptures. The study by Moller et al, as cited in the 2010 article 1, found significantly fewer reruptures in patients treated surgically, highlighting the mechanical advantage of direct tendon reapproximation in surgical repair. Some key points to consider in the management of Achilles tendon rupture include:

• The patient's age, activity level, and comorbidities, which can influence the decision between surgical and non-surgical management
• The importance of comprehensive rehabilitation programs, regardless of the initial treatment choice, to restore strength and function
• The potential risks associated with surgery, such as infection, wound complications, and anesthesia-related issues, which must be weighed against the benefits of lower recurrence rates. Overall, the choice between surgical and non-surgical management should be individualized, taking into account the patient's unique circumstances and preferences, as well as the potential benefits and risks of each approach, with the goal of minimizing morbidity, mortality, and optimizing quality of life.

From the Research

Comparison of Recurrence Rates

• The recurrence rates for patients with Achilles tendon rupture who undergo surgical repair versus those who opt for non-surgical management have been compared in several studies 2, 3, 4, 5, 6.
• A meta-analysis of randomized controlled trials found that the surgical group had a significantly lower re-rupture rate (OR: 0.30,95% CI: 0.18-0.54; P < 0.00001) compared to the non-surgical group 2.
• Another study found that the total re-rupture rate was significantly lower in the surgical group than in the non-surgical group (risk ratio 0.38,95% confidence interval 0.21 to 0.68; p = .001) 3.
• A systematic review of randomized controlled trials also found that open surgical repair was associated with a significantly lower re-rupture rate compared to nonoperative treatment (3.6% vs 8.8%; odds ratio, 0.425; 95% confidence interval, 0.222-0.815) 5.
• However, one study found that the re-rupture rates were equivalent in the non-surgical group and the surgical group if an early range of motion exercises protocol was performed (p = .08) 6.

Complications and Functional Outcomes

• The surgical group had a higher risk of other complications, such as deep infections, noncosmetic scar complaints, and sural nerve sensory disturbances 2, 5.
• However, the surgical group also had better results in functional outcomes, such as abnormal calf (OR: 0.45,95% CI: 0.26-0.76, P = 0.03) and torque for plantar flexion 2.
• Another study found that the surgical group had better results in functional outcomes when evaluated by jump tests and muscular endurance tests, but the two groups had no significant difference in the proportion of patients returning to previous levels of sporting activities (p = 0.87) 6.