Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 7 , ISSUE 1 ( January-June, 2020 ) > List of Articles

Original Article

Nonoperative Management of Achilles Tendon Rupture: A Clinical Debate

Khalid Al-Dadah, Ramesh Pal

Keywords : Accelerated functional rehabilitation, Achilles tendon rupture, Acute tendo-Achilles rupture, Nonoperative

Citation Information : Al-Dadah K, Pal R. Nonoperative Management of Achilles Tendon Rupture: A Clinical Debate. J Foot Ankle Surg Asia-Pacific 2020; 7 (1):10-13.

DOI: 10.5005/jp-journals-10040-1113

License: CC BY-NC 4.0

Published Online: 30-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Aim: To analyze the effectiveness of nonoperative modern management in patients with ruptured tendo-Achilles when compared with operative management. Background: Ruptured tendo-Achilles is a common pathology presenting to the orthopedic department. It mostly occurs during spontaneous activity in active male patients between the age of 30 and 40. Traditional nonoperative management consisted of a period of nonweight-bearing in an equinus cast for 6 weeks. When comparing this nonoperative management regime with operative repair of tendo-Achilles ruptures, many studies found that rerupture rates increased, and peak strength decreased in the nonoperative group. We look at the results of nonoperative management when the accelerated functional rehabilitation protocol is used compared to operative management. Review results: In a patient with a ruptured tendo-Achilles, employing nonoperative management using the accelerated functional rehabilitation protocol was comparable with operative management. In multiple high-level studies, both groups showed no difference in rerupture rates, peak strength, return to work, return to sport, patient satisfaction, range of movement, and clinical and functional outcome. One study demonstrated improved exercise at high velocity in the operative group in the short-term; however, the clinical significance of this is yet to be analyzed. Conclusion: Operative management of ruptured tendo-Achilles carries risks that are difficult to manage, in particular wound breakdown requiring subsequent revision surgery and tendon transfers. It was previously proven that operative management had decreased rerupture rates and improved strength. It has now been proven that when using the accelerated functional rehabilitation protocol, results are comparable to the operative group, without going through the risks of surgery. Clinical significance: Our group recommends strong consideration toward employing nonoperative management of ruptured tendo-Achilles using the accelerated functional rehabilitation protocol over operative management. Exceptions to consider are open injuries from lacerations, avulsion from the calcaneal attachment, or strong wishes from the patient, such as an elite athlete.

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