Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial.
BACKGROUND
Surgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative.


OBJECTIVE
Nonoperative treatment of acute Achilles tendon rupture with functional bracing reduces the number of complications compared with surgical treatment with a minimally invasive technique.


METHODS
Randomized controlled clinical trial; Level of evidence, 2.


METHODS
Using concealed random allocation, 83 patients with acute Achilles tendon rupture were assigned to nonoperative treatment by functional bracing or minimally invasive surgical treatment followed by tape bandage. Patients were allowed full weightbearing, and follow-up was 1 year.


RESULTS
Complications risk other than rerupture by intention-to-treat basis was 9 in 42 patients (21%) for surgical treatment and 15 in 41 patients (36%) for nonoperative treatment (risk ratio, 0.59; 95% confidence interval, 0.29-1.19). Reruptures risk was 5 in 41 patients after nonoperative treatment and 3 in 42 patients for surgical treatment (risk ratio, 0.59; 95% confidence interval, 0.15-2.29). The mean time to work was 59 days (SD, 82) after surgical treatment and 108 days (SD, 115) after nonoperative treatment (difference, 49 days; 95% confidence interval, 4-94; P < .05). The difference between treatments for return to sports (risk ratio, 0.55; 95% confidence interval, 0.23-1.29), pain, and treatment satisfaction did not reach statistical significance.


CONCLUSIONS
There appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.
Metz
Roderick
R
Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, Netherlands. metz_r@hotmail.com
Verleisdonk
Egbert-Jan M M
EJ
van der Heijden
Geert J-M-G
GJ
Clevers
Geert-Jan
GJ
Hammacher
Erik R
ER
Verhofstad
Michiel H J
MH
van der Werken
Christiaan
C
D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D001915:Braces; D005260:Female; D005528:Foot / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D020127:Recovery of Function; D012421:Rupture; D053656:Tenodesis / Q000009:adverse effects; D016896:Treatment Outcome; D016474:Weight-Bearing