Do Achilles tendon ruptures need surgical repair?

Muscle force through the Achilles tendon provides the “spring in our step.” Forces through the tendon are huge even with routine walking, so it’s no wonder that ruptures of the Achilles tendon are common.

The great debate of the past few decades has been whether it is better to treat a rupture surgically or non-surgically. While some tendons in the human just won’t heal without surgical help, the Achilles tendon can heal well without surgery if treated properly. (There is a strict non-surgical treatment protocol that must be followed.) There are even recent studies that suggest surgery might not offer any better results. So why are so many surgeons still performing Achilles repair surgery?

Most modern research studies say the biggest benefit of Achilles tendon repair surgery is a lower chance of re-rupturing the tendon in the future. But the reality is that a re-rupture is very uncommon either with or without surgery. The most important "take home" point from these research studies is that most patients (both surgical and non-surgical) have not reached their full strength and are still recovering at 6 months after injury.

Here is what we know about Achilles tendon ruptures:

  1. Full recovery takes a long time, more than 6 months, especially when thinking about return to high-level athletics.
  2. Surgery offers a slightly faster start to the rehab process, and a slightly faster overall healing time, although the times are long either way.
  3. Surgery takes away some of the uncertainty.

That last point is the most important. The vast majority of patients that have a successful tendon repair surgery will make a great recovery (full athletic participation). Many non-surgical patients will get there too, but a small number of non-surgical patients will not get their full strength back. They may be missing some strength, which will be noticeable with athletics. An even smaller number of non-surgical patients may even have a limp. The numbers are small, but those are some pretty frustrated patients.

Dr. Greisberg has performed hundreds of Achilles tendon repair surgeries. There have been no infections in any of those surgeries, and no re-ruptures in any sport following repair. He continues to treat about a quarter of new rupture patients non-surgically, especially those patients whose athletic goals are more limited. In the end, the patient needs to know the issues and facts, and the patient then makes the right decision for him or her. It’s the doctor’s job to provide the correct diagnosis and the facts about the options.