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Dr Eric Plotkine (orthopedic surgeon)
According to a study published in The New England Journal of Medicine, the treatment of a ruptured Achilles tendon without surgery would give better results. Should we therefore abandon the surgical solution? The answers of Dr. Plotkine, orthopedic surgeon and traumatologist.
With a length of almost 15 centimeters and a thickness of 5 centimeters, the Achilles tendon is the largest tendon in the body. It is used for walking, running, jumping and allows ankle flexion. When it is overstretched, it can end up weakening: this is rupture. How to repair it when it is broken? What are the possible techniques? Answers.
Achilles tendon rupture: better results without surgery?
EU study published Thursday, April 14 in the journal The New England Journal of Medicine discusses and analyzes the results of a multicenter trial comparing nonoperative treatment, conventional surgical repair, and minimally invasive surgery in 526 adults with acute Achilles tendon rupture.
The participants, evaluated for a year on the good healing of their tendons, obtained at the end a score oscillating between 0 and 100 – the highest scores indicating a better state of health.
The results of the study showed that the non-operated group scored the most points, followed closely by the conventional surgery group and then by the minimally invasive surgery group. The researchers also found “9 nerve lesions in the minimally invasive surgery group (in 5.2% of patients) versus 5 in the open surgery group (in 2.8%) and 1 in the non-operative group (in 0.6%)”.
Result: for the team of scientists, surgery did not reveal “better results” than non-invasive treatments. But for Dr. Eric Plotkine, this conclusion should be qualified: “It all really depends on the break – whether it is high, medium or low. The higher the break, the better it heals. On the other hand, if it is located in the lower part, at the bone insertion of the tendon, it is necessary to have the operation automatically”.
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Achilles tendon rupture: possible treatments
To repair a ruptured tendon, several techniques are possible to reattach the two pieces of tendon: surgery, orthopedic immobilization using a cast, the percutaneous technique (two threads are attached on either side of the rupture)…
The choice of treatment depends above all on the patient’s profile, but also on the location of the rupture: “The most frequent rupture is that of the middle part, in the body of the tendon. In this case, two possibilities: either one operates if one observes a large gap between the two stumps – because healing is impossible – or one considers a natural treatment if one observes a contact between the two parts”says Dr. Plotkine.
Other important information:The choice of treatment also depends on the patient’s profile: young, old, athletic or not… Thus, if a rupture of the body of the tendon is not operated in a young athlete, there is a high risk of recurrence of rupture. (15%). The operation, on the other hand, considerably reduces these risks (5%)”concludes the orthopedic surgeon.