Non-Operative Management

A systematic review of non-operative treatment compared to operative treatment of acute Achilles tendon ruptures identified four level II studies including all operative techniques.^18-21 Three studies included standard open treatment and one included a minimally invasive technique. Increased complications were noted in the open operative group.

When the outcomes of open and minimally invasive techniques were considered separately, the preliminary strength of recommendation was moderate.  The group agreed that it was important to evaluate both functional outcomes and complications comparing non-operative and all operative treatment groups. When these heterogeneous groups were separated into non-operative and operative (including minimally invasive) treatments, the strength of recommendation was downgraded to  limited.

The functional outcomes were favorable in the operative group in 1 of 2 level II studies and the return to activity and sport in 1 of 3 level II studies.  Only 1 of 4 studies demonstrated improvement in the rerupture rate in the operative group.  The remainder of the studies demonstrated no difference between the groups.

Higher complication rates, primarily due to impaired wound healing in the operative group, demonstrate the importance of awareness of surgical risk factors in the decision making of operative versus non-operative treatment (see Recommendation 6).

With acceptable functional results and lower complication rates than operative treatment, non-operative treatment of acute Achilles tendon ruptures is an option in all patients, especially those with increased surgical risk factors.