Management of Achilles tendon rupture: surgical versus conservative method

Introduction Current therapy for managing achilles tendon rupture are classified into surgical and conservative method. Randomized controlled trials were performed in multiple healthcare facilities in multiple centers across the world yet functional outcomes, re-rupture rate and complications are still indecisive. The aim of this study is to compare surgical versus conservative methods for the treatment of acute Achilles tendon rupture; including functional outcome, re-rupture rate, and complications to provide better guidance in selecting therapeutic method. Materials and Methods We conducted a comprehensive electronic database. Original articles until November 2023 were screened, focusing on randomized controlled trials with at least 12 months follow up. Our protocol has been registered at PROSPERO ID (CRD42023486152). Results and Discussion The initial search yielded 354 studies. Twelve randomized controlled trials study with a total of 1525 participants were assessed. Surgical treatment has better outcomes for preventing: re rupture (p ≤ 0.001), abnormal ankle movement (p ≤ 0.001), and calf muscle atrophy (p = 0.005). Functional outcomes at 6 months follow-up were better for hopping (p ≤ 0.001), heel-rise height (p ≤ 0.001), and heel rise work (p = 0.007) in surgical treatment. Functional outcomes at 12 months of follow-up were better only for heel rise work test (p ≤ 0.001) in surgical treatment. However, incidence of sural nerve injury (p = 0.006) was found lower in the conservative group. Complications other than re-rupture (p = 0.08) had no significant difference between two groups. At 6-month follow-up, functional outcome tends to be better compared to conservative management of Achilles tendon rupture. At 12-month follow-up, functional outcomes was comparable between two groups. However, the risk of re- rupture rate is higher in the conservative management. Conclusion Reduced rates of re-rupture and quicker functional recovery are benefits of surgical repair. Conservative treatment can yield good results in terms of functional outcomes and re-rupture rates in long term follow up, particularly when combined with contemporary rehabilitation procedures. Conservative treatment eliminates the hazards associated with surgery, but it may have a slightly higher chance of re rupture and a shorter initial recovery of some functional outcomes. Both of these treatment methods are good for treating Achilles tendon rupture. Level of Evidence: I.