I am madly looking through anything I can find on the internet about Achilles tendon ruptures and how to treat them. My 35-year-old husband thinks he's still in high school so while he was playing basketball with the neighborhood kids, he tore his Achilles. The decision we have to make is surgery or no surgery. What do you advise?
The debate about the most optimal treatment for Achilles tendon ruptures is ongoing. There are so many variables and factors to consider that it's hard to sort them all out, research them, and then come up with straightforward black and white answers.
For example, there's the decision to treat initially by repairing the rupture surgically versus the nonsurgical approach of putting the lower leg in a cast for six (plus) weeks. If surgery is done, which technique works best: open incision or arthroscopic percutaneous (through the skin with tiny puncture holes but no incision)?
When the leg is immobilized (whether that's right away or after surgery), should it be done with an adjustable brace or a rigid cast? How long should the leg be kept immobile so the tendon can heal? And finally, what's the best course of rehab? There are many decisions to be made in this arena as well.
Many studies show that the long-term results are equal between these two choices. The differences tend to come in the early months of recovery. Patients who have surgery tend to reach their rehab milestones sooner than those who don't have the tendon repaired. It may be that self-healing just takes longer but the eventual result is the same.
What it boils down to is patient and surgeon preference -- at least that's the approach until more conclusive data can guide treatment. The surgeon will evaluate the severity of the injury, the level of patient activity, and advise you accordingly.
You will, of course, have to evaluate your insurance coverage for surgery and for months of follow-up rehab. In the early phases, direct supervision of a physical therapist is advised but later, a significant portion of the program can be done at home. This might be a factor if you don't have reimbursement for rehab services.
Katarina Nilsson-Helander, MD, PhD, et al. Acute Achilles Tendon Rupture. In The American Journal of Sports Medicine. November 2010. Vol. 38. No. 11. Pp. 2186-2193.
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