Should surgery be opted for Achilles Tendon rupture? Study says no benefit

Norway: In a new study conducted by Stale B. Myhrvold it was seen that at 12 months, surgery (minimally invasive surgery or open repair) was not linked with better results than nonoperative therapy in individuals with Achilles tendon rupture. The findings of this study were published in The New England Journal of Medicine.

It is unclear if open-repair or minimally invasive surgical repair of an acute Achilles' tendon rupture is associated with better results than nonsurgical therapy. A randomized, multicenter, controlled trial evaluated nonoperative therapy, minimally invasive surgery, and open repair in persons with acute Achilles' tendon rupture who presented to four trial locations. At 12 months, the primary outcome was the change from baseline in the Achilles' tendon Total Rupture Score (scores range from 0 to 100, with higher scores reflecting better health). The incidence of tendon re-rupture was one of the secondary outcomes.

The key findings of this study were as follows:

A total of 554 patients were randomly assigned, and 526 of them were included in the final analysis.

The nonoperative group had a mean change in the Achilles' tendon Total Rupture Score of 17.0 points, the open-repair group had a change of 16.0 points, and the minimally invasive surgery group had a change of 14.7 points.

Pairwise comparisons revealed no indication of group differences.

Fitness level and patient-reported physical function improvements from baseline were similar in all three groups.

The nonoperative group had more tendon re-rupture than the open-repair or minimally invasive surgery groups.

The minimally invasive surgery group had 9 nerve damage, compared to 5 in the open-repair group and 1 in the nonoperative group.

In conclusion, surgery significantly reduces the chance of re-rupture, but dynamic therapy does not. This degree of control may be difficult to replicate in clinical practice, which may be especially problematic for nonoperative patients because both surgeons and patients may better appreciate the severity of an injury treated surgically.

Reference: 

Myhrvold, S. B., Brouwer, E. F., Andresen, T. K. M., Rydevik, K., Amundsen, M., Grün, W., Butt, F., Valberg, M., Ulstein, S., & Hoelsbrekken, S. E. (2022). Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture. In New England Journal of Medicine (Vol. 386, Issue 15, pp. 1409–1420). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2108447