Surgical repair vs. non-operative management of acute Achilles tendon ruptures: Current evidence and controversies.

Abstract

The Achilles tendon is one of the most robust tendons of the human body, and unfortunately, the most ruptured. Historically, surgical management was the golden standard, aiming to restore baseline activity with low re-rupture rates. With the development of new functional rehabilitation protocols, the paradigm started shifting towards nonoperative approaches, to avoid surgical complications. Moreover, the introduction of adjunct therapies, such as low-level laser therapy, extracorporeal shockwave therapy, or plasma-rich-protein injections, widened the scope of treatment. While both surgical and nonoperative approaches have demonstrated comparable outcomes, an ideal treatment algorithm is still a subject of debate. This literature review meticulously studies major trends in surgical and nonoperative management of acute Achilles tendon ruptures, describing most prevalent techniques and protocols, comparative results, and complication rates. It also highlights the latest updates on the use of adjunct therapies and injections, aiming to guide clinical decision making in treating this common injury.