Operative Treatment
Operative treatment is an option in patients with acute achilles tendon rupture.
LIMITED RECOMMENDATION Rationale
To answer this recommendation, we reviewed studies addressing the efficacy of operative treatment. A systematic review of the literature included eight studies20, 19, 27, 28, 29, 30,31, 32that addressed the efficacy of open repair and six studies33, 29, 34, 21, 27, 31, addressing the efficacy of minimally invasive techniques. This systematic review addressed only the efficacy of operative treatment and therefore did not consider the comparisons made in the studies. Please refer to Recommendation 3 and its rationale for a comparison of non-operative and operative treatment of acute Achilles tendon ruptures. In addition, relevant comparative information about operative techniques can be found in Recommendation 8 and its rationale.
A systematic review of the literature included eight studies20, 19, 27, 28, 29, 30,31, 32 that addressed the efficacy of open repair and six studies33, 29, 34, 21, 27, 31 addressing the efficacy of minimally invasive techniques. By six months the return to activity ranged from 73% to 100% after operative treatment. After twelve months, 92% of patients reported they had no pain.
All studies relevant to this Recommendation were Level IV because this is non comparative data.
A systematic review of the literature included eight studies20, 19, 27, 28, 29, 30,31, 32 that addressed the efficacy of open repair and six studies33, 29, 34, 21, 27, 31 addressing the efficacy of minimally invasive techniques. By six months the return to activity ranged from 73% to 100% after operative treatment. After twelve months, 92% of patients reported they had no pain.
All studies relevant to this Recommendation were Level IV because this is non comparative data.
- (19) Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med 1993;21(6):791-799.
- (21) Metz R, Verleisdonk EJ, van der Heijden GJ et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial. Am J Sports Med 2008;36(9):1688-1694.
- (27) Bhattacharyya M, Gerber B. Mini-invasive surgical repair of the Achilles tendon-does it reduce post-operative morbidity? Int Orthop 2008.
- (28) Uchiyama E, Nomura A, Takeda Y, Hiranuma K, Iwaso H. A modified operation for Achilles tendon ruptures. Am J Sports Med 2007;35(10):1739-1743.
- (29) Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon--a prospective randomized controlled study. Foot Ankle Int 2001;22(7):559-568.
- (30) Coutts A, MacGregor A, Gibson J, Maffulli N. Clinical and functional results of open operative repair for Achilles tendon rupture in a non-specialist surgical unit. J R Coll Surg Edinb 2002;47(6):753-762.
- (31) Aktas S, Kocaoglu B. Open versus minimal invasive repair with Achillon device. Foot Ankle Int 2009;30(5):391-397.
- (33) Ng ES, Ng YO, Gupta R, Lim F, Mah E. Repair of acute Achilles tendon rupture using a double-ended needle. J Orthop Surg (Hong Kong) 2006;14(2):142-146.
- (34) Chillemi C, Gigante A, Verdenelli A et al. Percutaneous repair of Achilles tendon rupture: Ultrasonographical and isokinetic evaluation. Foot and Ankle Surgery 2002;8(4):267-276.
- (35) Gigante A, Moschini A, Verdenelli A, Del TM, Ulisse S, de PL. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc 2008;16(2):204-209.