Optimal Treatment of Achilles Tendon Rupture Surgical versus Conservative Treament

Clinical Scenario: Determining the optimal treatment for a complete achilles tendon rupture to return the individual to their normal activities with the lowest re-rupture rate is a commonly discussed topic in the active population. Focused Clinical Question: With patients who have sustained an achilles tendon rupture, what are the differences in re-rupture rate for of surgical versus conservative treatment? Search Strategy: Inclusion criteria consisted of the injury needing to be a complete rupture, no previous history of ankle surgeries on the affected ankle and a positive Thompson test on each patient. Exclusion criteria were a history of chronic ankle instability, previous surgery on the affected ankle, and patients over older than seventy years of age. Databases searched included CINAHL complete, ProQuest Nursing Collection, PubMed and Cochrane Library. Search terms included achilles tendon rupture, surgical treatment, conservative treatment, operative treatment, and non-operative treatment. Nine articles were selected after the search was complete. Evidence Quality Assessment: All studies received either a 6/10 or a 7/10 on the PEDro scale. The studies were rated a level 2 or level 3 on the 2011 Oxford Centre for Evidence-Based Medicine levels of evidence scale. Results and Summary of Search: The number of 52 study participants range between 30 to 72 and were 18-65 years of age. There were no significant differences (p\u3e.19) between the surgical and conservative treatments on re-ruptures rate. Re-rupture rates ranged between 2% to 9.5% for the surgical group and 4.2% to 14% for the conservative treatment group. Even though surgical treatment proves to be a better option, all studies considered conservative treatment as a viable option when treating an achilles tendon rupture. The main benefits associated with operative treatment included the reduction in the duration of cast immobilization and overall lower re-rupture rate. However, the main drawbacks include the potential of surgical complications and wound infections. Eight out of nine studies concluded that although there were no statistically significant differences between groups, there were fewer re-ruptures in the surgical repair group. One major strength of the research was having similar number of participants in the operative and conservative treatment groups. The primary weakness included wound infections in the open surgical repair groups up to 8.4%. Within the research there was a lack of follow-up which made it difficult for to see how the treatment in the long term benefited individuals. Clinical Bottom Line: Overall, there were fewer re-ruptures in the surgical group compared to the conservative group. The study received a SORT score was A. Implications: Athletic trainers commonly work with lower leg injuries and may encounter achilles tendon ruptures throughout their careers. Athletic trainers need to be able to recognize the injury and determine the best possible treatment for achilles tendon ruptures