Nonsurgical and surgical treatments provide successful outcomes for an Achilles tear

January 9, 2017, American Academy of Orthopaedic Surgeons

A new literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) found successful outcomes for an Achilles tendon tear with either minimally invasive surgery or nonsurgical bracing with a removable boot, especially in recreational athletes. The use of platelet rich plasma (PRP), the injection of plasma-enriched platelets at the injury site, was not deemed an effective treatment.

A tear (rupture) of the Achilles tendon—the largest tendon in the body that connects the calf muscles to the heel bone—is among the most common injuries, affecting approximately 30,000 Americans each year, primarily recreational athletes age 30 to 49.

Earlier studies found a higher rate of re-injury, as well as a greater risk for related wounds and infection, with nonsurgical casting following an Achilles tear. Today, nonsurgical treatment options include —the use of an adjustable, removable boot that allows for movement and exercise—providing a lower risk for infection and re-rupture than immobilization with a hard cast. Surgical repair of an Achilles tendon tear, which also has evolved to minimize the risk of complication and infection, may still be optimal for high-performance athletes, or patients in physically-demanding professions.

Among the research findings highlighted in the review:

  • Re-injury rates with functional rehabilitation were lower than previously reported; recent research found no difference in re-rupture rates between functional rehabilitation and minimally invasive surgical repair (a small incision with minimal disruption of the surrounding soft tissue).
  • There were no significant long-term differences in ankle range of motion, strength, calf circumference, or functional outcome scores between patients undergoing functional rehabilitation and those with surgical treatment.
  • Functional rehabilitation resulted in faster return to mobility and work compared with casting for eight weeks.
  • Surgical treatment (full, open or minimally invasive) was associated with return to work up to 19 days earlier than nonsurgical treatment; however, specific criteria for returning to work were not defined in the research parameters and likely varied among the studies.
  • Patients undergoing surgery had a small, yet statistically significant increase in plantar flexion (flexing of the ankle when pointing the foot and toes) strength at one and two years after surgical repair, which may be advantageous for high-performance athletes.

"The treatment of acute Achilles tendon ruptures has evolved over the last decade demonstrating improved outcomes with functional rehabilitation compared to prolonged cast immobilization," said Anish Kadakia, MD, associate professor of orthopaedic surgery at Northwestern University-Feinberg School of Medicine, and lead author of the article. "Given the high demands of the athlete, minimally invasive surgical treatment should be considered over non-operative management as it minimizes the soft tissue complications while maximizing the power and strength of the patient."

Finally, there is no existing research to support the use of platelet-rich plasma injections for Achilles tendon tears, as studies, to date, found no improvement in functional outcomes with use. However, the use of bone marrow-derived stem cells has shown promising results in animal studies.

Explore further: Minimally invasive Achilles tendon surgery reduces complications

Related Stories

Minimally invasive Achilles tendon surgery reduces complications

February 10, 2015
Brian Frias was rounding second base and heading to third when he heard a sharp snap in his Achilles tendon.

Nonsurgical repair of achilles tendon may be preferable

December 12, 2012
(HealthDay)—Although surgical repair of a ruptured Achilles tendon is thought to reduce the risk of rerupture, nonsurgical management shows similar rerupture rates when functional rehabilitation with early range of motion ...

Achilles tendon ruptures missed in one of four cases, but surgery not needed for most

October 29, 2015
Achilles tendon disorders are common and often misdiagnosed, with about 25 percent of ruptures missed during initial examination, but the prognosis is favorable for the vast majority of patients, according to researchers ...

Stem cells inside sutures could improve healing in Achilles tendon injuries

March 12, 2014
Researchers have found that sutures embedded with stem cells led to quicker and stronger healing of Achilles tendon tears than traditional sutures, according to a new study published in the March 2014 issue of Foot & Ankle ...

NFL players' careers most affected by surgery to patellar tendon, Achilles tendon and ACL

September 6, 2016
In the hard-hitting world of American football, injuries are an inherent risk of the game with players in the National Football League (NFL) experiencing a higher rate of injury than in any other professional sport. Orthopaedic ...

Achilles tendon injuries more likely in male 'Weekend Warriors' than others

April 24, 2013
Male athletes are the group most likely to tear their Achilles tendon, according to a new study published in the April 2013 issue of Foot & Ankle International (FAI). The activity most likely to cause the injury was basketball, ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.