If you rupture your Achilles tendon, you’ll face two options – undergo an operation to repair the damaged tendon, or opt for a non-surgical method that leaves you on crutches or a non-weight bearing cast. Ultimately it comes down to your individual case, your doctor’s assessment, and of course, your wishes. Usually I recommend surgery as it allows the patient to bear weight sooner, and studies have shown it leads to a decreased likelihood of re-rupture, but again, it’s up to the patient.
A recent study published in The American Journal of Sports Medicine tried to determine if one method of Achilles tendon repair treatment was better than the other, so they conducted a cohort study using 93 patients who had torn their Achilles.
For their study, researchers evaluated the participants at 3, 6, and 12 months after injury or surgery. They also noted possible predictors of outcome failure or success, like body-mass index, age, and physical activity.
The Results
After analyzing the data, researchers found:
- At the 6-month appointment, surgical treatment was associated with a larger heel-rise height.
- At the 12-month follow-up, non-surgical treatment was associated with a larger heel-rise height.
- Surgical treatment was associated with a lower degree of symptoms at 12 months.
- Older age was associated with a lower heel-rise height.
- Patients with a higher BMI exhibited a greater degree of symptoms than those with a lower BMI.
This is an intriguing study with a great long-term follow up. As I expected, surgery was associated with less symptoms at one year.
As for the findings surrounding BMI, it makes sense that a heavier person would put more strain on their Achilles, but I am not a fan of using BMI in studies. BMI is only correlated with fatness. Many people with large amounts of muscle appear to be obese or morbidly obese on a BMI test. However, the finding is important that the more you weigh relative to your height, the more symptoms you will have a year after an Achilles tendon rupture.
The most intriguing finding is when the authors state that participants had a greater heel-rise height at one year in nonsurgical treatment. This is confusing as most literature has shown greater strength with surgery in follow up. I would like to see another study take a look at this aspect.
Given the decrease in symptoms and the more rapid return of strength, I still believe that active patients should undergo surgery.
Related source: AJSM