Factors That Determine the Outcomes of Surgical Versus Conservative Management in Achilles Tendon Ruptures: A Retrospective Cohort Study.

INTRODUCTION

Achilles tendon rupture is the most commonly ruptured tendon in humans. Recent evidence suggests no significant differences in long-term functional outcomes between conservative and surgical management. Conservative treatment carries a higher risk of re-rupture, while surgical management presents risks such as wound infections and sural nerve damage. This retrospective cohort study aims to compare functional outcomes and patient-specific factors in conservative versus surgical management of Achilles tendon ruptures using the Achilles Tendon Total Rupture Score (ATRS).

METHODS

Hospital electronic records from a major acute teaching hospital were reviewed to gather data on patients treated for Achilles tendon rupture. Patients were categorised into surgical or conservative treatment groups, and ATRSs were recorded at least one year post-injury. Statistical analysis, including the Wilcoxon rank sum and Welch t-tests, was used to compare ATRS outcomes between the groups. Outcomes were also stratified by age, sex, side of rupture, and tendon gap did not yield significant differences in outcomes. Notably, all female patients in this study were treated conservatively, precluding direct gender comparisons within the surgical treatment group. In addition, no consistent trends emerged regarding the side or specific location of the rupture.

RESULTS

The final sample comprised 25 patients, excluding those with missing data and patients over 75 years old. No significant difference was observed in the overall ATRS between the surgical (mean 89.9) and conservative (mean 89.2) management (p = 0.662). However, older males (aged 51-75) demonstrated better outcomes with surgical management (mean ATRS 95.4) compared to conservative management (mean 86.2, p = 0.027). Younger males (aged 18-50) showed a trend toward better outcomes with conservative treatment (mean 91.9) compared to surgery (mean 80.7), although this was not statistically significant. Patients with larger tendon gaps (≥20 mm) had higher ATRSs regardless of treatment modality, but these findings did not reach statistical significance.

CONCLUSIONS

This study found no significant difference in long-term functional outcomes between conservative and surgical management of Achilles tendon ruptures. However, older males benefited more from surgery, while younger males showed a trend toward better outcomes with conservative treatment, but the decision to offer surgery should not be based on age alone. Better functional outcomes were found irrespective of the tendon gap in both groups. Further research with larger sample sizes is needed to validate these findings and guide patient-specific treatment decisions.