In case of rupture of the Achilles tendon, it is possible to choose between surgery or immobilization by plaster. A new study shows that the 2 strategies give equivalent results.
In a study published in the BMJ, the surgical treatment of recent ruptures (less than 2 weeks) of the Achilles tendon reduces the risk of recurrence compared to non-operative treatment. But it must be admitted that the re-rupture rates are low and that the differences between the treatment groups are therefore small: risk difference of 1.6%.
Conversely, surgical treatment has a higher risk of complications than conservative treatment: risk difference of 3.3%, mainly due to an increased risk of infection.
A frequent rupture
Rupture of the Achilles tendon is a frequent injury (31 per 100,000 per year), affecting both non-athletes and athletes (male sportsman in his forties, during running or football). It is more common in the young working population with an age of onset around the forties, but recent studies indicate that the frequency of Achilles tendon rupture continues to increase due to a more active older population. This tendon can rupture when it has been weakened by degeneration of the tendon fibers (overweight, dehydration, pre-existing tendonitis).
An injury to the Achilles tendon can be disabling due to its major role in walking. The treatment of a recent rupture of the Achilles tendon can be surgical or medical (conservative treatment) but it is still the subject of much discussion.
Often late diagnosis
In 20-30% of cases, the diagnosis of an Achilles tendon rupture is not made at the first consultation, which is problematic because early repair gives better results.
The Achilles tendon is a strong tendon that attaches the lower calf to the heel. It helps lift the heel when walking and running. Rupture results in sharp pain in the heel and calf, swelling of the posterior aspect of the ankle, impossibility or great difficulty in walking.
A marked depression may form above the heel. Although it is possible to walk with little pain, it is not possible to stand on tiptoe.
A study that clarifies the data
Previous meta-analyses included only controlled clinical trials and showed that surgical treatment of recent Achilles tendon ruptures appeared to significantly reduce the risk of secondary tendon rupture compared to conservative treatment. With the addition of observational studies, which increases the number of patients analyzed, this meta-analysis shows that the rates of second rupture and complications are much lower than expected with surgery (compared to previous studies), and that the differences between treatment groups appear to be small, such that the benefits of surgical treatment may not outweigh the risks associated with the procedure (even including studies of minimally invasive surgery). The durations of immobilization and the time to return to sport are also close.
Therefore, conservative treatment with an equine cast may be an acceptable option for the treatment of recent Achilles tendon ruptures. Patients should be informed of the benefits and risks of both treatment options and surgeons should know when not to operate.
In practice
A young athlete will therefore be more likely to have surgical treatment. On the other hand, an elderly person, smoker, diabetic and non-athlete will be treated medically. For the majority of patients, who are between these two extremes, an open dialogue informed by information on the advantages and risks of each treatment must be carried out between patient and doctor so that the patient can choose the most appropriate treatment. its needs
“Good surgeons know how to operate, the best when to operate and the best when not to operate.”
.