19/10/2025
📌◼️ Achilles Tendon Ruptures: Finding the Right Fix – Surgery vs. Nonsurgical Management
If you're an active adult, you know Achilles tendon ruptures are becoming increasingly prevalent. But when a tear happens, the critical decision lies between surgical repair (open or minimally invasive) and nonsurgical management.
The main idea of the research highlighted by Rachit Saggar, M.B.B.S., Joseph Mullen, B.S., Peter G. Mangone, M.D., and MaCalus V. Hogan, M.D., M.B.A., is that choosing the optimal treatment requires balancing the risks of rerupture against the risks of surgical complications.
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🩺 The Core Trade-Offs
◼️ Meta-analyses confirm the key dilemma: Surgery significantly reduces the risk of rerupture (relative risk, 0.43; 95% confidence interval, 0.31-0.60).
◼️ Specifically, rerupture rates are 2.3% with surgery versus 3.9% with nonsurgical management.
◼️ However, the cost of this reduced rerupture risk is a higher complication rate (relative risk, 2.76).
📌Surgical Benefits and Risks
◼️ Surgical treatment offers advantages in recovery speed: patients return to work approximately 19 days earlier on average and demonstrate faster strength recovery (18% greater at 18 months).
◼️ However, surgery introduces specific risks:
• Wound Infections: Open repair has a 6% infection rate. Minimally invasive (MIS) repair is much lower at 0.4%.
• Nerve Injuries: MIS approaches carry a higher risk of sural nerve injury (5.2% total; 3.4% specifically when compared to open repair's 0%). Open repair nerve injury risk is 2.8%.
• DVT: Deep vein thrombosis risk is 1% for surgical treatment.
◼️ The good news for surgical options is that minimally invasive approaches generally match open repair outcomes while providing fewer superficial infections.
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📌Nonsurgical Efficacy and Cost
◼️ Nonsurgical management, especially incorporating early weightbearing protocols, has shown comparable functional outcomes in selected patients.
◼️ The large UKSTAR trial (n=527) specifically validated that functional bracing is an effective alternative to plaster casting, showing no significant differences in rerupture rates or Achilles Tendon Rupture Scores.
◼️ While surgical management is costlier overall, it results in lower indirect costs, which is likely attributed to the faster recovery and return to work it enables.
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👥 The Modern Strategy: Patient-Centered Care
◼️ The main takeaway for modern treatment strategies is the emphasis on patient-centered care.
◼️ Treatment selection should align with the individual's needs and goals:
• Surgery is generally recommended for younger, high-demand patients.
• Nonsurgical options are suitable for those with lower functional requirements or comorbidities.
◼️ Ultimately, shared decision-making is essential to ensure the treatment plan aligns with individual patient goals, leading to improved satisfaction.
◼️ Rehabilitation, particularly early mobilization, is critical for optimizing outcomes, regardless of whether the patient chooses surgery or nonsurgical management.
Link to Article 👇
