Surgical versus Non-Surgical Treatment for Acute Achilles Tendon Rupture: A Systematic Review

Abstract

Introduction: The optimal management of acute Achilles tendon rupture is controversial, with both surgical repair and non-surgical functional rehabilitation being viable options. This review compares the outcomes of these two approaches.

Methods: We conducted a search of MEDLINE and CENTRAL for RCTs comparing surgical repair to non-surgical management for acute Achilles tendon rupture. The primary outcome was the rate of re-rupture.

Results: The meta-analysis of 15 RCTs demonstrated that surgical repair resulted in a significantly lower rate of re-rupture compared to non-surgical treatment. However, surgery was associated with a higher risk of other complications, such as wound infections and nerve injury. Functional outcomes were similar between groups when modern functional rehabilitation protocols were used.

Discussion: There is a clear trade-off: surgery lowers the re-rupture risk at the expense of an increased risk of wound and nerve complications. The gap in re-rupture rates has narrowed with the advent of modern accelerated rehabilitation protocols for non-surgical patients.

Conclusion: Surgical repair for Achilles tendon rupture reduces the risk of re-rupture but increases the risk of other complications compared to non-surgical treatment.