Acute Achilles tendon rupture is a common orthopedic injury that typically occurs in physically active individuals. Prompt and appropriate treatment is crucial to ensure optimal recovery and prevent long-term complications. In their LIterature Review, Treatment of Acute Achilles Tendon Rupture, Seung-Hwan Park, MD, Ho Seong Lee, MD, Ki Won Young, MD, and Sang Gyo Seo, MD, discuss various treatment options for acute Achilles tendon rupture, their outcomes, and provide recommendations for clinicians.
The Achilles tendon is the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone. It plays a vital role in various activities such as walking, running, and jumping. Rupture of this tendon can significantly impair mobility and function, necessitating timely intervention.
The authors review three primary treatment approaches for acute Achilles tendon rupture:
- Non-Surgical (Conservative) Treatment:
- Non-surgical management involves the use of functional bracing or casting to immobilise the ankle.
- It is typically recommended for less active individuals or those with significant medical comorbidities that make surgery risky.
- This approach allows the tendon to heal naturally, but it often leads to longer recovery times and a higher risk of re-rupture.
- Percutaneous Minimally Invasive Surgery:
- Minimally invasive surgery involves making small incisions to repair the ruptured tendon using special instruments.
- This technique aims to minimise scarring and postoperative complications.
- It is favored by some surgeons for its potential advantages in terms of quicker recovery and reduced risk of infection.
- Open Surgical Repair:
- Open surgical repair involves a larger incision and direct visualisation of the ruptured tendon.
- It provides better access for precise repair and is often preferred for athletes and individuals with high physical demands.
- However, it may carry a higher risk of complications such as infection and wound healing problems.
Comparing Treatment Outcomes: The authors discuss several key factors that influence the choice of treatment and compare outcomes:
- Re-rupture Rate:
- Non-surgical treatment is associated with a higher risk of re-rupture, especially in younger, more active patients.
- Surgical approaches, whether minimally invasive or open, generally result in lower re-rupture rates.
- Functional Outcomes:
- Functional recovery, including strength and range of motion, is a critical consideration.
- Some studies suggest that surgical treatment may lead to better functional outcomes in the long term.
- Surgical approaches carry a higher risk of complications, including infection and wound healing issues.
- Non-surgical treatment has a lower risk of complications but may result in longer recovery times.
Based on their review, the authors provide recommendations for the treatment of acute Achilles tendon rupture:
- Patient Factors:
- Treatment decisions should consider the patient’s age, activity level, and overall health.
- Younger, more active individuals are often better candidates for surgical repair.
- Non-surgical treatment may be suitable for older patients or those with significant comorbidities.
- Surgical Approach:
- The choice between minimally invasive and open surgical repair should be individualised.
- Surgeons should consider patient preferences, surgical expertise, and potential risks when making this decision.
- Postoperative rehabilitation plays a crucial role in achieving optimal outcomes.
- A structured rehabilitation program should be tailored to each patient’s specific needs and circumstances.
The management of acute Achilles tendon rupture is a complex decision that requires careful consideration of various factors. This study by Seung-Hwan Park, MD, and colleagues highlights the importance of personalised treatment approaches based on patient characteristics and preferences.
While surgical repair tends to result in lower re-rupture rates and better long-term functional outcomes, it also carries a higher risk of complications. Non-surgical treatment may be suitable for certain patient populations but often leads to longer recovery times.
Ultimately, the choice of treatment should be made collaboratively between the patient and their healthcare provider to ensure the best possible outcome. Further research and clinical studies may continue to refine treatment guidelines for this common orthopedic injury.
Park, S.-H., Lee, H. S., Young, K. W., & Seo, S. G. (2020). Treatment of Acute Achilles Tendon Rupture. Clinical Orthopaedics and Related Research, 12(1), 1–8. https://doi.org/10.4055/cios.2020.12.1.1