A Canadian meta-analysis presented at the AAOS meeting confirms that early mobilization after Achilles tendon rupture essentially negates the difference in re-rupture rate between operative and nonoperative treatments.
Most meta-analyses of operative vs nonoperative management of Achilles rupture, including a Cochrane review from the University of Western Australia published in September, have concluded that re-rupture rates are significantly lower following surgery. However, few of the randomized studies included in those meta-analyses reflect the recent paradigm shift away from cast immobilization and toward bracing with a device that is removable to facilitate early mobilization (see “Achilles rupture redux,” January, page 13).
In the Canadian meta-analysis, researchers from Dalhousie University in Halifax, NS, assessed 10 randomized studies and found that re-rupture rates differed by only 1.6% if early mobilization was used but 8.8% if it was not utilized. Nonoperative treatment had a 15.8% lower risk of postoperative complications, but patients who underwent surgery returned to work an average of 19.6 days sooner. Calf circumference, strength, and functional outcomes did not differ significantly between groups.