SLR - October 2011 - Kyle S. Peterson
Reference: Keating, J.F., Will, E.M. (2011). Operative versus non-operative treatment of acute rupture of tendo Achillis: A prospective randomized evaluation of functional outcome. J Bone Joint Surg Br, 93-B, 1071-8.
Scientific Literature Review
Reviewed by: Kyle S. Peterson, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance:
Acute rupture of the Achilles tendon is a common injury seen in middle-aged men, or a “weekend-warrior.” The purpose of this paper was to determine if the functional outcome following surgical repair of an acute Achilles tendon rupture provides a better recovery of muscle function compared to non-operative treatment consisting of cast immobilization.
Methods:
Eighty patients were randomized to have operative open repair (39) or non-operative treatment (41) in a cast for 10 weeks. Data was collected at admission, and at 3, 4, 6 and 12 months post-operative. Outcomes measured included: clinical complications, Short Musculoskeletal Function Assessment Questionnaire (SMFA), ankle joint range of motion compared to the uninjured limb, and muscle function dynamometry evaluating dorsiflexion and plantarflexion.
Results:
Two patients (5.4%) in the operative group had re-ruptures while four patients (10.3%) had re-ruptures in the non-operative group (p=0.676). Three infections (8.1%) were encountered in the operative group while none were found in the non-operative group. Range of motion differences were essentially equivocal for plantarflexion and dorsiflexion throughout one year, except at week 26, where the mean range of plantarflexion in the operative group was 5 degrees greater in the operative group (p<0.02). A significant difference was found at 12 weeks for the peak torque difference of plantarflexion compared with the uninjured limb in the operative group versus the non-operative group (47% vs 61%, respectively, p<0.005). The dorsiflexion peak torque remained similar without any significant difference at any stage between both groups. At three months, the mean SMFA scores were significantly better in the operative than non-operative group (15 vs 20, respectively, p<0.03). The scores remained similar after this without any statistical difference between both groups at one year. The return to previous levels of sporting activity, work, and time to driving were not statistically significant throughout the follow-up period.
Conclusions:
The author’s failed to demonstrate a significant functional benefit associated with treating acute Achilles tendon ruptures operatively. Based on their findings, they do not recommend operative management, although the re-rupture rate is less than non-operative treatment. They believe cast immobilization remains a viable option to avert the complications of surgery.