Conservative treatment?!
Hello All,
I recently completely ruptured my Achilles tendon on 12/1/14 playing recreational basketball (former college basketball player). I am currently a graduate student at a large research institution, and my orthopedic surgeon is an associate professor and treats many of the elite athletes at my school. When I first met with him, he gave me a choice between surgical intervention vs. conservative treatment (cast then boot). He said I was a “tweener” based on my high activity level and “young” age (30 y/o). I did however have some degeneration in my tendons due to boxing and playing basketball all of these years. Anyway, I trusted his judgement and interpretations of the science, and subsequently declined surgery due to the risk of complications associated with any invasive treatment. Since the ends of my ruptured tendon overlap when my toe is pointed (as seen on my ultrasound), my surgeon was very comfortable with me undergoing nonsurgical intervention. In fact, within the last five years, he has moved away from performing surgeries on this type of injury (for non-elite athletes, anyway).
I have been somewhat concerned about the re-rupture rates associated with a nonsurgical procedure, but my surgeon has assuaged these fears by stating that both the published literature and his personal/anecdotal experiences as a physician have not shown a heightened risk associated with conservative treatment. My biggest fears are that (1) I won’t be able to run/sprint after this injury and (2) I won’t be able to engage in high-intensity weight lifting exercises.
Has anyone had conservative treatment for a complete rupture? What was your prognosis?
December 22nd, 2014 at 4:38 PM
Lots of people have gone non-op with excellent results, Lauren! Including ~950 in one published study from Ireland, which reported a 2.9% rerupture rate - lower than many surgical studies - and 100% return to sports. That study and 2 other recent studies showing great non-op results with aggressive non-op ATR treatment are summarized and linked at AchillesBlog. com/Cecilia/protocols.
The key to those great results - as opposed to the high rerupture rates from older (<2007) non-op studies - is apparently that the modern studies weren’t at all “conservative” except in skipping the operation. I.e., the new ones went very fast, generally used boots vs. casts, got to PWB and exercise and PT around 2 weeks into treatment, FWB by 4 weeks, and 2 shoes at 8.
In addition, the Irish study checked, and used, the angle that just brought the torn AT ends together, as your OS apparently did. (Though Wallace in Ireland just did it with his eyes and hands, without MRI or Ultrasound. Boys and toys, OMO!) I think you’re following the best evidence-based path, provided your schedule stays close to one of the schedules listed on Cecilia’s page.