Surgery or Conservative Treatment for Achilles Tendon Rupture

Conservative treatment has become more common in Finland and the Netherlands over the past decade. Re-rupture rates are 4 to 10 percent with conservative care and 2 to 4 percent after surgery. The higher figures come from randomized trials with about 1,000 patients, and the lower ones from the Ochen meta-analysis of nearly 15,000 patients across study designs. Surgery carries a risk of infection, around 3 percent in Ochen and about 5 percent superficial and 2 percent deep in the trials. Sural nerve lesions were reported in almost 8 percent in trials that asked about them, against 0.4 percent in Ochen. Overall complications were about 5 percent after surgery and 1.5 percent with conservative care. ATRS function and patient satisfaction did not differ at six months or a year, and rehabilitation is similar. The guideline recommends conservative treatment as the first option, especially for people at higher risk of complications such as obesity, older age or smoking, and considering surgery for athletes in explosive sports. Surgical technique matters less than the surgeon's experience with it.