I need some quick help. Just took my son to the doctor’s for a calf injury. Looks like he has a torn Achilles tendon. Doc gave us the run down on surgery versus no surgery and what to expect. I need a few more details before deciding which way to go. What can you tell me? What works best? How do we decide?

The best way to manage acute Achilles tendon ruptures has not been discovered. One important outcome of successful treatment is to avoid rerupture or other complications (e.g., infection, bleeding into the muscle, adhesions, altered skin sensation, blood clots). A recent meta-analysis of 14 studies with over 1000 patients performed at the University of Western Australia provides some helpful information.

All patients were adults who had injured their Achilles tendon in the previous three weeks. Most were males who were engaged in athletic activities at the time of their injury. Analysis of all the data collected from the studies showed the following:

  • There were fewer cases of rerupture when patients had surgery to repair the torn tendon.
  • When short-term immobilization in a cast is followed by the use of a functional brace (instead of surgery), rates of re-rupture were the same as with surgery. This approach is referred to as accelerated rehabilitation.
  • The best way to avoid rerupture appears to be with surgical intervention followed by cast immobilization.
  • The highest rate of reruptures occurred in patients treated nonoperatively just with cast immobilization.
  • Complications (other than rerupture) were higher in the surgical patients.

    Sports athletes or other participants in sports activities can expect to get back to full swing of daily activities and sports involvement six months after surgery. Whether the surgery is done percutaneously (through the skin) or with open incisions doesn’t seem to affect the results in terms of the rerupture rate. Patients in the open incision group did have significantly higher rates of postoperative infection.

    The final decision may be influenced by the patient’s age (young adults tend to heal faster than the elderly), severity of the injury, and surgeon’s preferences. At least from the results of this meta-analysis, percutaneous repair with cast immobilization after surgery seems to offer the best long-term results.