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Am Fam Physician. 2004;69(10):2458

There are two main treatment options for acute rupture of the Achilles tendon: operative repair and nonoperative care. The nonoperative option has been shown to produce good results with reasonable complication rates. Operative treatment may provide a stronger repair with a faster rehabilitation and, in the long term, better Achilles tendon strength with less risk for rerupture. However, surgical treatment also carries with it operative morbidity. Early functional activity has been shown to be beneficial in operative and non-operative treatment plans. Weber and colleagues evaluated the results of a nonoperative treatment program for acute Achilles tendon rupture and compared the results with those of an operative program.

The study design was a retrospective investigation of two groups of patients at one institution who had acute rupture of the Achilles tendon. Patients who were treated surgically had a simple tendon suture and were rehabilitated in a “walker” in neutral ankle position, with full weight bearing as soon as tolerated. The non-operative protocol included the use of an equinus ankle cast, rehabilitation in a boot with a heel lift, and full weight bearing as soon as tolerated. After the initial treatment, patients were reassessed at three, six, and 12 months, and at the final visit. During the evaluations, the resting length of the muscle-tendon unit and ankle plantar flexion were measured, dynamometric testing was performed, and the ability to stand on the injured foot with a single-legged heel raise for one minute was recorded. In addition, subsiding of pain, return to unaided walking, return to work, and complications were noted.

The nonoperative group had faster subsiding of pain, return to unaided walking, and return to work, compared with the operative group. All patients were permitted to bear full weight as soon as tolerated. There were no differences between the two groups with regard to patient satisfaction, return to sports, and ultimate strength. The complication rates were similar between the two groups except for reruptures. Patients in the nonoperative group were more likely to have a rerupture than patients in the operative group.

The authors conclude that patients with acute Achilles tendon rupture who receive nonoperative care have the same results as patients treated with operative repair.

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