Historically, it was thought that the surgical approach to repairing achilles tendon ruptures was significantly superior to the non-surgical approach. Besides slightly faster recovery times and better final outcomes in terms of leg strength, the key advantage of surgical treatment lay in significantly lower re-rupture rates.
On average, re-rupture rates after non-surgical treatment were around 20 percent, and re-rupture rates from surgical treatment were around 5 percent or less in most studies. See more on studies in support of surgical treatment of achilles tendon ruptures.
There are some older studies and findings that suggest much lower differences in re-rupture rates. However, it was not until 2008 and onwards that major studies started coming out suggesting that non-surgical treatment was just as effective as surgical treatment. Below is a list of studies and findings in chronological order that support non-surgical treatment. The key factors behind a successful outcome and low re-rupture potential from non-surgical treatment are:
- Functional bracing.
- Early weight bearing and mobilization.
Bolded studies below are especially worth reading.
Older studies — I tend to ignore older studies that did not cover early weight bearing and mobilization, but for those interested, this article refers to a number of studies. The earliest is from 1972 by Lea and Smith (1972), and continues with studies from Lildholt, Termansen, Nistor and more.
1988, Japan — 100 patients treated non-surgically and then monitored.
1993, Germany — 22 patients, regular ultrasonographic monitoring, “absence of complications and excellent functional results.”
2003, Switzerland — 23 patients’ nonoperative treatment of acute rupture of the achilles tendon. Between 1996 and 1998.
2004, UK — The famous Wallace report findings, 140 patients between 1992 and 1998.
2007, New Zealand — Twaddle, 1-year patient follow-up.
2011, UK — Wallace, close to 1,000 patients treated conservatively between 1996 and 2008, only 2.8 percent re-rupture rate.
2010, Canada — 144 patients split evenly between surgery and non-surgery.
2012, UK — The important Devon & Exeter experience, 246 patients between 2008 and 2012.
2012, Sweden — 487 patient study of surgical and non-surgical patients treated between 2002 and 2006. One to seven year post-treatment relatively long-term analysis.
2012, UK — a superb and huge two volume thesis by Rebecca Samantha Kearney.
May 2013, Netherlands — Very interesting summary of 576 patients treat surgically or non-surgically between 2001 and 2012, divided by early weight bearing (defined as within 4 weeks) and late weight bearing (defined as after more than 4 weeks).
August 2013, Denmark — A completed clinical trial. Using dynamic rehabilitation and early weight-bearing (compared with non-weight-bearing).
February 2021, China — Collectively, the authors recommend conservative treatment if patients expectations are reasonable.
April 2022, Norway — The largest ever study of 524 patients concludes as follows: “In patients with achilles tendon ruptures, surgery was not associated with better outcomes than nonoperative treatment at 12 months.” The media widely covered these “surprising” findings.