Achilles tendon rupture. A review of the literature comparing surgical versus nonsurgical treatment.

Rupture of the Achilles tendon is being reported more frequently. Results published in the literature in the past 25 years were reviewed to determine the overall outcome comparing surgical with nonsurgical treatment and to identify areas needing further study. The rerupture rate for surgically treated patients was 12/777 or 1.54%, while that for nonsurgically treated patients was 40/226 or 17.7%. The complication rate for surgical treatment was 155/775 or 20.0%, while the nonsurgical rate was 2/20 or 10%. Most complications did not affect the eventual outcome. Time lost from work averaged 13 weeks for surgically treated patients and nine weeks for nonsurgically treated patients. Results of tests for functional recovery after treatment were slightly better for surgically treated patients and were worse for patients with reruptures treated nonsurgically. No study tested strength at a specified joint angle; this constitutes a major flaw in strength-testing studies, because strength is related to the functional joint position. The difference in cost between surgical and nonsurgical treatment, including the cost of rerupture treatment, may not be significant.