title: Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial.
abstract: 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.
authors.affiliation: Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, Netherlands. metz_r@hotmail.com
authors.forename: Roderick
authors.initials: R
authors.lastname: Metz
authors.forename: Egbert-Jan M M
authors.initials: EJ
authors.lastname: Verleisdonk
authors.forename: Geert J-M-G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Clevers
authors.forename: Erik R
authors.initials: ER
authors.lastname: Hammacher
authors.forename: Michiel H J
authors.initials: MH
authors.lastname: Verhofstad
authors.forename: Christiaan
authors.initials: C
authors.lastname: van der Werken
mesh_terms: 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