Achilles tendon injury: Operation or orthotics?

Surgery for a torn Achilles tendon means a bit less chance of a new tear than with treatments that keep the leg immobilised. But adverse effects from surgery are common, including wound infections.

The Achilles tendon joins the calf muscles to the back of the heel. It is one of the thickest and strongest tendons in the body, but it can also tear. Usually this happens during sport, and it is men between the ages of 20 and 40 who more often have this injury. But it can also happen when someone falls off a ladder or while climbing stairs.

There are basically two options for treatment. So-called conservative treatment involves putting the leg in plaster or a functional brace to keep it still until the tear can heal itself. The second option is surgery, where the two ends of the torn tendon are sewn back together. This used to be possible only through a large incision or cut through the skin. Many clinics these days use a minimally invasive type of surgery. Using special instruments, it is then possible to do the surgery through a much smaller incision under the skin. This is called percutaneous surgery. The leg needs to be immobilised after the operation as well.

To try to answer the question about which of these alternatives have better results, researchers from the Cochrane Collaboration analysed 14 trials that involved almost 1,000 people.

The result was that an operation offered better prospects for a more stable Achilles tendon. In about four out of every 100 people (4%), the tendon tore again after the operation. This compared with 13 out of every 100 people (13%) who did not have an operation. That means that an extra 9 out of 100 people (9%) avoided re-rupture because of surgery.

However, about 34 people out of every 100 who had surgery (34%) had to deal with complications like wound infections, adhesions or numbness. It is possible that minimally-invasive surgery might reduce the rate of wound infections, but this has not been proven.

The researchers also wanted to know if there was a difference between having a plaster cast or a lighter functional brace. This choice made no difference to the stability of the tendon. However people who had a functional brace got out of hospital faster and were back at work and their usual activities quicker. And they had fewer complications.

Published: April 16th 2006 19:05
Source: Khan RJ K, Fick D, Brammar TJ, Crawford J, Parker MJ. Interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews, Issue 3 of 2004. (Cochrane Database)

Glossary

Cochrane Collaboration

The Cochrane Collaboration is an international network of thousands of researchers and others. They work together in teams called Cochrane Review Groups to answer questions about health care by doing systematic reviews of evidence. To achieve this, the members of the Collaboration have developed systems and methods for systematically finding and analysing the results of trials of health care interventions. The goal of the Cochrane Collaboration is to help patients, health care practitioners and others make more informed decisions about health care. You can read more about the Cochrane Collaboration at their website.