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Surgery for Achilles Tendon Ruptures?

The Achilles tendon is the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone. However, it is susceptible to injury, particularly Achilles tendon rupture, which can result in significant functional impairment. When faced with an Achilles tendon rupture, patients and healthcare professionals are often confronted with the decision of whether to pursue operative or non-operative management.

Surprisingly, given the traumatic presentation of an Achilles tendon rupture, non-operative management is typical in the large majority of cases. In the past non-operative management meant near total immobilization in a cast to allow the tendon to heal in anatomic position. This approach is still used occasionally in older and less active individuals. The most recent data supports an early progressive weightbearing protocol utilizing a special walking boot to keep the tendon ends from displacing. Utilizing this method, in 8 weeks, most people are able to be walking flat in a normal shoe. This conservative approach aims to promote natural healing and gradual return to normal activities without surgical intervention.

Operative management involves surgical intervention to repair the torn Achilles tendon. This approach is typically recommended for young and active individuals, athletes, and those with a complete rupture. The surgical technique usually involves making an incision over the tendon and suturing the torn ends together. One of the key advantages of operative management is the potential for more precise anatomical alignment and tension restoration, which may contribute to improved strength and function during the early healing process. Typically patients see a 6-8 week decrease in the time required to return to sport.

When comparing operative and non-operative management, several factors need to be considered. In terms of functional outcomes, studies have shown that both approaches can lead to satisfactory results. While operative management may offer a slight advantage in terms of a quicker return to pre-injury levels of activity, non-operative management is still a viable treatment even for athletes.. Obviously, the risk of complications, such as infection or wound healing problems is significantly higher with operative management.

Re-rupture rates are a significant concern in the management of Achilles tendon ruptures. While operative management may have lower re-rupture rates compared to non-operative management, the difference in re-rupture rates between the two approaches is not substantial. Recent studies have shown that with appropriate rehabilitation and adherence to a structured program, the risk of re-rupture can be minimized in both groups. This finding has led to a shift in practice, with an increasing trend toward non-operative management.

In conclusion, the decision between operative and non-operative management of Achilles tendon rupture should be made based on a thorough evaluation of the patient's individual circumstances, preferences, and goals. Both approaches have their merits and can lead to satisfactory functional outcomes. Operative management may provide a slight advantage in terms of a quicker return to activity, while non-operative management is generally less invasive and more cost-effective.

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