Achilles Tendon Tears: Is Surgery Necessary?

Achilles tendon tears are one of the most common tendon injuries in our body.  The injury commonly occurs from pushing off while playing sports such as basketball or tennis.  When you tear or rupture your achilles tendon you will hear and feel a loud snap.  You will inevitably turn around to see who shot you or hit you.

After an achilles tendon tear most of you will head to the ER.  They will diagnose you and give you a boot and a pair of crutches.  An achilles tendon tear is not a challenging diagnosis to make.  Questions are now swirling around your head.  Everyone you know is offering you advice.  But what does the current research show about the management of achilles tendon tears. Do all achilless tendon injuries need surgery?  Will my function be compromised if the tear is treated without surgery?

Do Achilles Tendon Tears Require Surgery?

The achilles tendon connects your calf muscles to your heel bone.  It provides the strength to push your foot down and jump forward.  It is one of the strongest tendons in the body, but unfortunately it tends to wear out as we age.  That degeneration of your achilles tendon can lead to weakening of the tendon.  Over time the tendon does not repair the damage from sports rapidly enough and the weakened achilles will tear when you jump or push off.  This tends to be a violent event. Most of you will recall that loud pop for quite a while.

Most of you believe that surgery will be necessary to repair your achilles tendon.  For many of you that is not true.  The scientific literature over the last 8 years has shown that non-surgical management of most achilles tendon tears will lead to a very successful result.   See our video below for our thoughts… circa 2017 … on the management of achilles tendon tears.

Achilles Tendon Ruptures:

 

One hundred patients were randomly assigned to surgery with early mobilization or to early mobilization alone with the removable orthosis (brace) and without prior surgery. In every other respect, all the patients in the study had the same treatment. The thesis (paper) shows that there is no difference in the re-rupture rate. A year after the injury, there was no difference in the patients’ own impression of symptoms and function, but irrespective of which treatment the patient received, the function tests showed that there remained a substantial difference between the healthy and the injured foot.

This controversy over how to manage achilles tendon tears has existed for years. My own experience is that the vast majority of patients treated non-operatively do just as well as those treated with surgery. I always present the options to the patient and allow them to decide, and the vast majority over the last few years have chosen non-operative management. The *promise* that surgery restores strength has not been proven to be true by the scientific studies. The only major difference between open and non-surgical treatments ruptures is the infection rate.  Infections do not occur in the non-surgery group.  And an infection around the Achilles tendon can be a nightmare.

Another paper presented at a major conference this year (2011) reveals that surgery offers little benefit over non-operative management of Achilles Tendon ruptures.   Surgically managed patients did *better* early on, barring any complications — but by one year after surgery there were no differences.