Review Question - QID 4686

Recent Level 1 evidence has failed to show significant differences in strength, ROM, SMFA scores, or re-rupture rates when comparing operative versus non-operative management. Studies have consistently shown increased complications rates with operative management, however.

There is much debate on the appropriate management of acute Achilles tendon ruptures. Historically, studies have shown increased re-rupture rates and decreased strength with non-operative management. Recent randomized, prospective studies have failed to show significant clinical differences, but continue to show increased wound complications with operative management.

Keating et al. prospectively randomized 80 patients to operative or non-operative management of acute Achilles tendon ruptures. At 1-year follow-up, they did not find statistically significant difference in re-rupture rate, strength, or Short Musculoskeletal Function Assessment (SMFA) scores.

Willits et al. prospectively randomized 144 patients to operative or nonoperative treatment for acute Achilles tendon ruptures. Re-rupture occurred in 2 of the patients treated operative and 3 treated non-operatively (not statistically significant). Additionally, there was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score.

Illustration A shows an MRI of a normal Achilles tendon compared to a ruptured Achilles tendon.

Incorrect Answers:
Answer 1: While some studies have shown increased plantar flexion strength, they have not shown a statistically significant difference in dorsiflexion strength.
Answer 2: Some studies have shown decreased dorsiflexion range-of-motion at 6 months in operative groups.
Answer 3: Level 1 evidence has shown no difference in SMFA scores at 12 months.
Answer 4: Classically, re-rupture rates have been higher in non-operative groups. New Level 1 data suggests no difference in re-rupture rates.