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This Article Full Text Full Text (PDF) Supplemental Data All Versions of this Article: 36/9/1688    most recent 0363546508319312v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Google Scholar Articles by Metz, R. Articles by van der Werken, C. PubMed PubMed Citation Articles by Metz, R. Articles by van der Werken, C. Related Collections Achilles tendon Operative

Acute Achilles Tendon Rupture

Minimally Invasive Surgery Versus Nonoperative Treatment With Immediate Full Weightbearing—A Randomized Controlled Trial

Roderick Metz, MD^,*, Egbert-Jan M. M. Verleisdonk, MD, PhD, Geert J.-M.-G. van der Heijden, MD, PhD, Geert-Jan Clevers, MD, PhD, Erik R. Hammacher, MD, PhD^||, Michiel H. J. Verhofstad, MD, PhD^¶ and Christiaan van der Werken, MD, PhD

From the Department of Surgery, University Medical Center, Utrecht, Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands, Department of Surgery Diakonessenhuis, Utrecht, Netherlands, ^|| Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands, and ^¶ Department of Surgery, St. Elisabeth Hospital, Tilburg, Netherlands

^* Address correspondence to Roderick Metz, MD, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, Netherlands (e-mail: metz_r{at}hotmail.com).

Background: Surgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative.

Hypothesis: Nonoperative treatment of acute Achilles tendon rupture with functional bracing reduces the number of complications compared with surgical treatment with a minimally invasive technique.

Study Design: Randomized controlled clinical trial; Level of evidence, 2.

Method: Using concealed random allocation, 83 patients with acute Achilles tendon rupture were assigned to nonoperative treatment by functional bracing or minimally invasive surgical treatment followed by tape bandage. Patients were allowed full weightbearing, and follow-up was 1 year.

Results: Complications risk other than rerupture by intention-to-treat basis was 9 in 42 patients (21%) for surgical treatment and 15 in 41 patients (36%) for nonoperative treatment (risk ratio, 0.59; 95% confidence interval, 0.29–1.19). Reruptures risk was 5 in 41 patients after nonoperative treatment and 3 in 42 patients for surgical treatment (risk ratio, 0.59; 95% confidence interval, 0.15–2.29). The mean time to work was 59 days (SD, 82) after surgical treatment and 108 days (SD, 115) after nonoperative treatment (difference, 49 days; 95% confidence interval, 4–94; P < .05). The difference between treatments for return to sports (risk ratio, 0.55; 95% confidence interval, 0.23–1.29), pain, and treatment satisfaction did not reach statistical significance.

Conclusion: There appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.

Key Words: Achilles tendon • rupture • treatment • complications