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Surgery may be best choice for high-performance athletes with Achilles tear

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Surgical and non-surgical treatments provide successful outcomes for an Achilles tendon tear, but surgery may be the best option for high-performance athletes.

That’s according to a literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

The review found successful outcomes for an Achilles tendon tear with either minimally invasive surgery or non-surgical bracing with a removable boot, especially in recreational athletes.

Although earlier studies found a higher rate of re-injury when patients had non-surgical casting, the latest non-surgical treatment options include functional rehabilitation — the use of an adjustable, removable boot that allows for movement and exercise after a brief two-week course of casting — and this is less likely to result in re-rupture than immobilisation with a hard cast. In fact, recent research found no difference in re-rupture rates between functional rehabilitation and minimally invasive surgical repair (a small incision with minimal disruption of the surrounding soft tissue).

Surgical repair of an Achilles tendon tear has also evolved, with the use of minimally invasive techniques and specialised instrumentation to minimise the risk of complication and infection, the authors noted. As such, this may still be optimal for high-performance athletes, or patients in physically-demanding professions.

In addition to a faster return to work (up to 19 days earlier than non-surgical treatment), studies found that patients undergoing surgery had a small increase in plantar flexion (flexing of the ankle when pointing the foot and toes) strength at one and two years after surgical repair, which may be advantageous for high-performance athletes.

“The treatment of acute Achilles tendon ruptures has evolved over the last decade, demonstrating improved outcomes with functional rehabilitation compared to prolonged cast immobilisation,” commented Dr Anish Kadakia, associate professor of orthopaedic surgery at Northwestern University-Feinberg School of Medicine, and lead author of the article. “Given the high demands of the athlete, minimally-invasive surgical treatment should be considered over non-operative management as it minimises the soft tissue complications while maximising the power and strength of the patient.”

The review also found that no existing research supports the use of platelet-rich plasma injections for Achilles tendon tears, as studies show no improvement in functional outcomes. However, the use of bone marrow-derived stem cells has shown promising results in animal studies, the authors said.