Surgical versus Conservative Treatment for Acute Achilles Tendon Rupture

Abstract

Background: Surgical repair is a common method of treatment of acute Achilles tendon rupture because, despite a higher risk of overall complications,it has been believed to offer a reduced risk of rerupture. However, recent analysis based on using early functional rehabilitation, have challenged this belief. The aim of this study is to evaluate the clinical effectiveness of both treatments.
Methods: The search was performed using the following electronic bibliography databases (Medline, CINAHL, PubMed and Cochrane Library) to find studies comparing surgical and conservative treatment for acute Achilles tendon rupture. The selection of items was based on inclusion and exclusion criteria.
Results: The studies showed that surgical treatment has a lower rate of rerupture (P=0.002) compared with nonsurgical treatment, but increases the risk of other complications (P=0.004). Subgroup analyses revealed significant differences in relation to scar adhesion (P<0.00001), superficial infection (P=0.05) and sensibility disturbance (P=0.0003) in the group undergoing surgery.
Conclusions: Compared with conservative treatment, operative treatment can effectively reduce the risk of rerupture but increase the probability of complications, which is usually associated with open repair surgery. However, no sufficient evidence is available from current studies to support the belief that operation may lead to better functional recovery.