Op or Non-op? Good question!

July 15th, 2013

I might catch a lot of people’s attention with that question but I certainly do NOT claim to have the answer. What I do think is that neither is right or wrong and both have advantages. There are all sorts of circumstances to consider and not even the experts can agree. Which ever road you take then that has to be the best road for you.

For me this was never really a question. I tore my meniscus saw a surgeon, had surgery, recovered, ran again. (Yes I have heard this too can repair itself.) I ruptured my Achilles while running in a race. I went to the ER, got some pain meds and a (bad) boot. Got up called my knee surgeon and had surgery by his partner that day. There was some discussion about pros and cons of op vs non op but honestly you would have to ask my husband about that. I was in pain, on pain meds and the non-op sounded all hokey and well tic toc people the sooner I was in the sooner I would be running…. right?! (Have I mentioned before that I am NOT a patient person?)

I went to a great sports medicine group with doctors I trust. They are the doctors for the Blazers, the Timbers and the Thorns. I had never heard much of anyone trying the non-op route until a few weeks later when I found this website. I have since coherently talked to my doctor about op/non-op and he still for me in order to return to my level of running op he feels the surgery was the best method. (I know some non-ops are thinking that statement is not true and really you very well may be right.)

I thought I would share a bit about my surgery. I had a “clean” rupture with little or no coiling- or so I have been told. (I can assure you I have not seen the proof). My doctor used a new technique with a “new tool” so I had a 1″-2″ horizontal incision rather than a longer vertical one. I pictured something like a small crochet hook but when @ATRbuff asked why I went the surgical route I did some googling and can only assume I found an article about my “tool”. I would like to thank ATRbuff as the article is very interesting but now I can never unsee some of the images! And the tool - not anything like a crochet hook….(erase erase erase!) I will do my best to post the article below but be warned. :)

My Scar

Hopefully here is the link to he article:

In the end I am still confident in my decision and in my doctor. (Well - except the part about making me sleep in the boot wwwaaayyyy to long….ssshhh don’t tell him I stopped a little early!) BUT - I think everyone is different and which ever route we are on we are all in this together. This is NOT a group I would voluntarily join but it has so helped me so much to read about all of you and your journeys; to read about your milestones, struggles and your advice.

24 Responses to “Op or Non-op? Good question!”

  1. lodinpdx on July 15, 2013 12:17 pm
  2. Fiddle on July 15, 2013 1:57 pm

    Wow! Seeing how that tool works is pretty cool. But, you won’t get the ooooh’s and aaaaah’s from having a long scar…:)

  3. skim92 on July 15, 2013 4:46 pm

    Omg.. I shouldn’t have looked through that link. If you have a weak stomach, I would not recommend it! It made my leg feel all weak and tingly thinking that’s what they did to me!
    But you are definitely so lucky to have such a small scar. I on the other hand have the extremely long vertical incision. Right now, it’s still covered mostly with steri-strips and big scabs. So I don’t know how bad the scar will actually be but it looks like its going to be a looker.

    I was told the same about op vs non-op. because I’m very athletic, I chose the op route to be able to return to athletics.

    Hope everyone is healing well!
    I started a blog before I found this site so to see me blog and recovery: http://achillesrecoverylog.blogspot.com

  4. lodinpdx on July 15, 2013 4:59 pm

    Thanks - I know - I thought it pretty cool but also pretty UUGGHH. I guess I like to not think about the details.

  5. lodinpdx on July 15, 2013 7:49 pm

    Skim - I will check out your blob oops blog. :) Yes those pics are hard to look at! I do feel lucky to have had my surgeon and surgery done the way he did it. Many people have the longer scar and everything works out well and as fiddle said you will forever have oohs and aahs over your scar. You can milk it for YEARS to come. :)

    @Hillie and other non-ops I will never know whether I would have been a non-op success story like you. @Kellygirl’s road to success story was really the first I had heard of such a thing! I certainly (now) think that it is viable option to consider. I also wonder if my doctor being a surgeon (with a newer toy/technique) would ever recommend such an option. I am not sure what a wiser and more patient me would consider. Being wiser but no less patient I just hope (and rehab to avoid) I will not be in a position in which I have to ponder such a question!! :)

  6. lodinpdx on July 15, 2013 8:06 pm

    @Skim - I just read your blog! Oh you poor thing!! BUT - you are one lucky girl to have such a nice boyfriend and parents with such a beautiful view!!

    I so know what you mean about the cost of the trip to the ER and really they did not do much - but at least they gave me pain meds! It sounds like it took a little bit of time but now you are on the right path. It is definitely a long bumpy road so check in here and keep us updated!

  7. normofthenorth on July 15, 2013 10:28 pm

    We’re FINALLY getting to the point where a number of professional and elite athletes with ATRs are going non-op with fast modern aggressive rehabs and getting wonderful results. Several of them are now posting on YouTube, including one Canadian Football League player (Brady Browne) who’s posted a large number of vids. As I recall, he was running up walls and the like at some crazy early point, like maybe 8-10 weeks post-non-op. . .

    But old myths die hard, and the new evidence showing wonderful non-op results only started getting published in 2007, which is pretty new stuff for most established professionals in a relatively boring field of medicine. The UWO study was only published in 2010, and the new study discussed on suddsy’s blog — showing <1% non-op re-rupture rates with even FASTER rehab than UWO — was even more recent, so way too new for most clinical doctors to know about.

    Unless the medical insurers of the world get tired of paying for ATR surgeries with no clear benefit, I think the ATR-treatment revolution will probably be led by patients with access to achillesblog.com and YouTube. . . One of the new “YouTube ATR athletes” has been documenting his SELF-treatment, non-op, without a Doctor(!).

  8. Fiddle on July 16, 2013 12:51 am

    @normofthenorth: I have a sprinter buddy that wants to pop his good achilles so he can have surgery and have it as strong as his repaired achilles.

  9. skim92 on July 16, 2013 1:32 am

    Thanks for checking out my blog and the encouragement! :)
    I’m definitely hitting bumps in this long road ahead everyday… But yes I’m thankful for those around me!
    I’m trying to find productive things to do but I keep getting stuck in a routine of Netflix and eating. The weight gain is definitely another one of those bumps! :(

  10. lodinpdx on July 16, 2013 12:02 pm

    @normofthenorth. I can agree with you that nonop is a viable option and I wish all non-op and op patients alike have successful outcomes. BUT it is not cut and dry and there is information out there to support both methods of treatment. Below is the opening line of the link I posted. It is from an article written in 2009.

    “Despite hundreds of publications in the medical literature on the subject of acute rupture of the Achilles tendon, the jury remains firmly out as far as agreement is con- cerned on its optimal treatment.”

    I think is has everything to do the with the injury, the patient and the doctor. You have to have trust in your doctor and believe that between the two of you you will make the right decision. Like Fiddle’s friend I have heard from a few people that their post-op bad Achilles is now stronger than the good one. Being me I certainly did not “weigh” the options but that is not to say that I would have chosen otherwise or regret my decision. I still think I ended up with the best possible solution for me.

  11. hillie on July 16, 2013 2:11 pm

    As you have time on your hands you could go back over the months and discover that Norm, me and many others are fully aware that treatment is not ‘cut and dry’ (interesting choice of words). Another few days of no treatment in my case did almost necessitate the knife. Some others turn out like a “plate of spaghetti”. In another post you said that your atr was a “clean” rupture with no coiling up.

    My sports and leisure pastimes require strong, reliable lower limbs and my consultant is a leading ortho surgeon - and still we went for non-op. My post non-op tendon and calf are absolutely up to scratch, maybe stronger than ever. It has been very hard work though. An accelerated protocol including and followed by increasingly intensive pt is the key for ‘most’ people.

    Check out the dates on the publications that you mention - pretty old many are. Since then UWO 2010 (Canada), Exeter 2012 (UK) have published protocols based on science, new thinking and results. The jury’s not out anymore - some just wish to disagree or ignore the verdict.

    You did however end up with the best solution for you - you are happy with your treatment. That’s great, just how it should be.

  12. superjewgrl on July 16, 2013 7:32 pm

    Well said Lodinpdx! I also like your scar. You don’t see too many of those on this site.

    I’m not sure why on this site it’s been commonly said that treatment delayed longer than two weeks requires surgical treatment. Not true. There is no consensus regarding the specific time in which an acute becomes a neglected rupture although 4 weeks may be the most widely accepted interval.

    But the fact is, we can publish what happens with a subset of this population, but how people respond to treatment is individual. Just as we see the myriad of different protocols prescribed to posting members of this site.

    I just prefer to support people in their healing, hear their story and contribute. I’m not sure what benefit there is to question someone’s decision.

    Happy Healing Lodinpdx!!

  13. brokendad on July 16, 2013 9:36 pm

    Just curious- does anyone know if the non op option more viable for certain ages or fitness levels?

  14. brokendad on July 16, 2013 9:50 pm

    Lynn- I may show your scar to my surgeon. Less cutting means less scar tissue and less wound complications. Of course, I would still want the long scar so I will look tough :)

    Thank you for sharing.

  15. hillie on July 17, 2013 2:39 am

    Questioning someone’s decision isn’t saying “you screwed up” or making any criticism. It’s all about understanding how, from the options available, individuals make the (hopefully with the best available advice) most suitable decision for them at that time.

    Questioning is about learning! The blog here is also about spreading new knowledge. And yes, of course it is about support too.

  16. bionic on July 17, 2013 4:26 am

    Lopin I am op as well and very happy moving forward with that. For all the non-op people do search the 9 month post injury of the video of the player that norm references. Wow that is inspiring!

    Lopin did your meniscus tear involve partial arthroscopic removal of the meniscus? Was it medial meniscus? Was it the same leg as your ATR?

    I ask because that description applies to me and I’m having some interesting (never bad, just interesting) issues with my knee as I’m getting to FWB and trying to walk through a stride with ankle locked at 5deg plantar.

  17. lodinpdx on July 18, 2013 12:42 pm

    Hi Bionic,

    How did you become bionic? We joke in our house about waiting around for bionic parts. Just wish with new parts we really could be bionic. I LOVED Jaime Sommers and so wanted her hair! :)

    Anyway - Yes on the partial arthroscopic removal. My doctor said it was a little like a hang nail that he snipped. I may have had the tear for a while but I stepped off curb funny and either made a little tear or dislodged an existing tear. I felt nothing much right away but that night it swelled up and hurt. It was a very distinct pin-point stabbing pain unlike most overuse injuries that tend be more vague. I did have an MRI but not a good one showed showed nothing. Your PT and/or dr can do some tests to help determine if that is what they suspect it is.

    As it seems related to the boot and limping my guess is it has more to do with tracking - I have that problem too! (See I ned a bionic knee) In my good leg (which used to be my bad leg) it has to do with my hips and glutes. (I have loads of exercises for that some I can do and some not yet - let me know if you want them) With my bad leg which was my good leg it is because I “walk” too peg legged which puts all of pressure in all the wrong places. The unevenness of the boot also caused stress on the knee. I think I mentioned before that I worry I will have loads of ailments post Achilles besides my Achilles!

    In the meantime try to think about bending, tracking as you walk. Oh and rolling through your foot, squish the bug….with no ducking….and putting even weight on both feet …and keeping your shoulders down and your eyes up but don’t fall over…. and and and…….. OR stay in bed! JUST kidding! :)

    Good luck!

  18. lodinpdx on July 18, 2013 12:52 pm

    Brokendad - You will have one nasty scar that you can use to your advantage for years to come. I suggest going sockless year round and roll that pant leg up haphazardly as to look like it was by accident. What’s that you say - how did I get this scar? It’s a crazy story…and it still kinda hurts perhaps you can give me that seat in first class so I can be more comfortable. :)

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  20. brokendad on July 18, 2013 8:13 pm

    Great idea Lodine. Does anyone have a really awe inspiring story I can use ? Every time time I tell mine I get the- of coursr you got huert , you too old to be doing that.

  21. Fiddle on July 19, 2013 12:14 am

    @brokendad: I get the “you’re too old to be doing that” too. Little do they know that there are 60 year old’s out there running way faster times than me.

  22. bionic on July 19, 2013 2:25 am

    Lopin, we’re all bionic since our surgeries. I just decided to go by the achilles blog family name here. I think I’m going to revist the 70s and watch a six million dollar man or bionic woman episode for extra inspiration.

    Thanks for the tips on the knee. I started FWB a few days ago (at home but still carrying crutches out). Prior to ATR, I’ve had what I like to call ‘high perfomance but whiny’ knees and ankles. My ATR is R leg and same leg as medial meniscus removal some 20 years ago. Significant part of meniscus scoped out.

    I noticed with FWB the sudden hypertension and swelling of my R knee. Before my ATR I was waiting for an MRIa of R knee. After ATR R knee was super as no hockey, football etc. Now with FWB swelling but not super painful, so just cool science for now.

    Thanks to your advice and other stuff here I found I see the hypertension with FWB is common. I resolved large part of it by returning to the larger (curved) vaco sole. That sole is suppose to be for 10deg and more and I’m at 5deg…and will learn the stride. But I got my two hands back…wow hands are such an amazing tool.

  23. bionic on July 19, 2013 2:48 am

    oops hyperextension… not hypertension.

  24. skim92 on August 29, 2013 12:19 am

    So jealous of your barely there scar! Looks great!

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