FRIDAY, Dec. 28 (HealthDay News) -- In the long run, patients
who rupture their Achilles tendon fare equally well following
nonsurgical treatment as they do with surgery, a new Canadian
research review shows.
The catch: Nonsurgical patients can only expect to see results
on par with surgery patients if they simultaneously engage in
so-called functional rehabilitation, a bracing process that offers
patients the opportunity to quickly engage in range-of-motion
exercises to promote tendon healing.
And even so, nonsurgical patients will experience a slower speed
of recovery than surgery patients.
"[But] if you rupture your Achilles you need to consider nonoperative treatment, because it's safer than surgical treatment," said study co-author Dr. Mark Glazebrook. "What this means is that if you have nonoperative treatment withfunctional rehabilitation you will have an outcome just as good as surgery andyou almost eliminate the absolute risk for surgical complications."
Glazebrook, an assistant professor of surgery in the division of
orthopedics at Dalhousie University Queen Elizabeth II Health
Sciences Center in Halifax, Nova Scotia, and colleagues discuss
their findings in the Dec. 5 issue of the
Journal of Bone and Joint Surgery.
The Achilles tendon -- located at the back of the leg, between
the heel and calf -- is the most commonly ruptured tendon, the
study team pointed out.
Nonsurgical treatment options typically involve the use of a
cast, a cast-boot or a splint, sometimes accompanied by physical
therapy or functional rehabilitation bracing. Such bracing is a
relatively recent innovation that enables patients to begin
monitored range-of-motion exercising very shortly after the initial
Nevertheless, in the United States, surgery has been the more
favored treatment route, in large measure due to the widespread
belief that the risk of re-rupturing is lower following surgery
than it is following nonsurgical interventions.
That said, while nonsurgical intervention is considered
extremely low risk, roughly 10 percent of surgical patients end up
developing serious complications, such as deep infection, skin
death, tendon death, and a draining sinus. About 15 percent will
also develop relatively minor skin complications.
The authors reviewed the findings of 10 Achilles tendon studies
conducted between 2005 and 2011. In sum, the studies included 418
patients who underwent surgery and 408 patients, mostly male, who
underwent nonsurgical treatment. Some patients had additionally
undergone functional rehabilitation, while others had not.
When functional rehabilitation was included in either treatment
mix, the investigators found no appreciable difference in the risk
for tendon re-rupturing when comparing surgical and nonsurgical
patients. Similarly, both sets of patients fared equally well in
terms of range of motion, calf circumference and overall function
when functional rehabilitation was in play.
However, when functional rehabilitation was not part of the
overall treatment package, surgery patients did face a lower risk
-- nearly 9 percent lower -- for re-rupture compared to nonsurgical
When looking at the four studies that assessed the time it took
for patients to return to work following treatment launch, the team
found that surgery patients did see a faster recovery, being able
to return to work about 19 days sooner than nonsurgical
Glazebrook and colleagues concluded that at institutions where
functional rehabilitation is available, the option to go the
nonsurgical route should be given consideration, given the
inherently lower risk for complications. But they added that when
functional rehabilitation is not an option, surgery should be the
For his part, Dr. James Barber, an orthopedic surgeon with the
Coffee Regional Medical Center in Douglas, Ga., lauded the
comparative analysis. "It really reinforces our understanding of
treatment options," he said.
"But my concern is that it not be misinterpreted as discounting the surgical option," he added, "because each of the choices is valid, depending on patient need. And this study clearly shows that there is no one answer for every patient," with each having to carefully weigh faster surgical recovery times versus the lower-risk/less-invasive nonsurgical approach, Barber explained.
"So I would say that for low-demand patients who are not required to get back to work quickly, nonsurgical treatment is a good way to go," Barber said. "But for others, surgery is a legitimate and well-thought-of option. And this study helps me lead the kind of decision-making process that's needed when considering these two choices."
As far as cost comparisons between surgical and nonsurgical
treatment, Barber said costs vary so much from hospital to hospital
that it's impossible to say which would be more for any given
For more about Achilles tendon injury, visit the health
information site at the
University of Wisconsin-Madison.