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Results of surgical versus non-surgical treatment of Achilles tendon rupture

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Abstract

Between 1990 and 2001, 292 patients with acute Achilles tendon rupture were admitted to our institution. Depending on the day of admission patients were allocated either to the Department of Trauma Surgery or to the Department of Orthopaedics. Two hundred and twelve patients (mean age 37±9.4 years) were treated with surgical suture followed by plaster for 6 weeks. Eighty patients were treated non-surgically with splinting for 12 weeks. For both groups mean follow-up was 6±3 years. There were 14 re-ruptures, ten after surgical repair and four after non-surgical treatment. In the surgical group there were seven major wound problems, 11 minor wound complications and six patients with complaints from the sural nerve. In the non-surgical group one patient suffered a pulmonary embolism after a re-rupture, 3 months after the initial rupture. There was no difference in mean ankle score and patient-satisfaction score between groups. Only 52% regained their original sports activity level, slightly better in the surgically treated group. With a non-significant difference in re-rupture rate but relatively more complications after surgical repair, non-surgical treatment is preferred. With a slightly better recovery of sports activity after surgical repair, this might be used as an argument for surgical treatment in young athletes.

Résumé

Entre 1990 et 2001, 292 malades avec une rupture du tendon d’Achille ont été admis dans notre institution. Selon le jour de l’admission les malades ont été alloués au Département de Traumatologie ou au Département d’Orthopédie. 212 malades (âge moyen 37±9,4 ans) ont été traité par suture chirurgicale suivie d’un plâtre pour 6 semaines et 80 malades ont été traités conservativement avec attelle pour 12 semaines. Pour les deux groupes la moyenne de suivi était de 6±3 années. Il y avait 14 ruptures itératives, 10 après réparation chirurgicale et quatre après traitement non chirurgical. Dans le groupe chirurgical il y avait sept problèmes majeurs de paroi, 11 complications mineures de paroi et six malades avec souffrance du nerf sural. Dans le groupe non chirurgical un malade a eu une embolie pulmonaire après une rupture itérative, trois mois après la rupture initiale. Il n’y avait aucune différence dans le score moyen de la cheville et le score de satisfaction des malades entre les deux groupes. Seulement 52% ont regagné leur niveau d’activité sportive original, légèrement mieux dans le groupe traité chirurgicalement. Avec une différence non significative dans le taux des ruptures itératives mais relativement plus de complications après réparation chirurgicale, le traitement non - chirurgical est préféré. La récupération sportive légèrement meilleure après réparation chirurgicale est un élément de discussion pour le traitement chirurgical chez les jeunes athlètes.

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Authors and Affiliations

  1. Orthopaedic Surgery Department, Leiden University Medical Center, Leiden, The Netherlands

    Henrica M. J. van der Linden-van der Zwaag & Rob G. H. H. Nelissen

  2. Trauma Surgery Department, Medical Centre Alkmaar, Alkmaar, The Netherlands

    Jan B. Sintenie

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  1. Henrica M. J. van der Linden-van der Zwaag
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  2. Rob G. H. H. Nelissen
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  3. Jan B. Sintenie
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Correspondence to Henrica M. J. van der Linden-van der Zwaag.

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van der Linden-van der Zwaag, H.M.J., Nelissen, R.G.H.H. & Sintenie, J.B. Results of surgical versus non-surgical treatment of Achilles tendon rupture. International Orthopaedics (SICOT) 28, 370–373 (2004). https://doi.org/10.1007/s00264-004-0575-9

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