Aug 25 2011
Op or No Op
Friday 19th August, the morning after the scans I wasted no time and rang the Consultant. Spoke with his secretary and luckily for me he had reviewed the scans shortly after the scan had been done. I was advised that the consultant thinks a non-surgical option is best and I need an appointment in two weeks to have the cast changed.
With this now being the 13thday since my injury, (I had obviously had plenty of time for research, reading blogs and talking with my friend who is still recovering from his rupture) I was curious as to why an operation was advisable. I made it clear that I would prefer an operation as I believed my age and active life would benefit from an operation and challenge this decision. Obviously his secretary wasn’t in a position to comment further so had to pass on my comments.
I was now beginning to think the delay getting home, the incorrect cast position for 4 days and the huge delay getting scanned had hampered my chances for a decent start to recovery. Why does the consultant prefer no op when clearly the rest of the world say an operation is the only approach.
Within 5 minutes I received a return call from my consultant. Firstly he wanted to know why I preferred to have an operation and I explained based on research and friends experience an operation was advisiable for a complete rupture especially when I’m still young and active. I wanted the best chance for a good and strong recovery. The chances of a re-tear were alot lower as well.
He went on to explain that surgery isn’t always the preferred route and comes with it’s own complications like infection being one of them but more importantly he said that surgery for my particular injury wasn’t possible.
Putting the partial tear to my inner calf muscle aside, apparently the complete rupture to my achilles tendon was higher than normal just above my ankle bone and there wouldn’t be enough good tendon higher up to use to stitch into. He said my achilles has ruptured away from the muscle and it wouldn’t stitch well.
I’m no expert and this advice seemed to be logical so what could I say. My only concern now was ’How big is the ‘Achilles Tendon’?’. Answers please…..based on images I’ve seen on google the achilles tendon travels right up to the large calf muscle so why isn’t there enough tendon to use.
4 responses so far
4 Responses to “Op or No Op”
Hello,
I had a full rupture on the 11th of April and wen’t non-opp. I torn my tendon in the same plance and my doc said stitching into tendon and muscle won’t work the chance of a rupture is small there’s about a 2% more of a chance with a non- opp and some studies say there is no difference. I was unlucky and had a bit of a scare where they thought I’d re-ruptured so I had to slow down my recovery a bit (now 4.5 months in a cast) but my leg now feels good, and is coming on good few weeks in an Aircast but what can you do. That said even after my ’scare’ I have no regrets about going non-opp, unless you really have to be cut open avoid it I say!
I’d say if you get a good feeling from you’re Doc, mine is great (NHS as well) go with what he says and it puts your mind at ease. As I’ve said there are studies done and of course it can re-rupture but that’s the same of opp vs. non- opp as with most things in life it’s the luck of the draw. Just don’t rush things, an extra week or two now won’t make that much difference in the long run.
I’ve done a little blog about the fun and games.
http://meandmyachilles.wordpress.com/
Good luck with your healing up.
All the best
Mark
Thanks Mark. Yeah I guess being disappointed about no op is a strange one. The consultant is a nice guy and sounds like he knows his business so I have confidence in him really.
You’ve been in casts for 4.5 months? That’s a long time before a air cast boot isn’t it. I’ve been in contact with Vacoped and there boot claims to be worthwhile after a couple of weeks of casts. Im hoping my consultant will be supportive in going this route but I will listen to him first.
Good luck with your recovery and I look forward to reading your blog.
Cheers
Rob
This was the reason for my previous comment about the muscle tear. I had a feeling the rupture was high. Trust your doctor on this. The AT is made up of 5 tendons (I think) and they all collide for want of a better word to form this one large tendon. There are plenty of good pictures and info on the net from technical sites that will help you better understand. Since you have the time on your hands it will make good reading and a time filler.
Pringles, your “clearly the rest of the world say an operation is the only approach” is way wrong in general, even if your ATR were in the “normal” spot. There are certainly some surgeons (most of them in the USA) who make their ATR patients believe that statement, but the newest and best evidence is much more balanced and nuanced. The risk of surgical complications is real and not insignificant, the other surgical “costs” ($, time off work, pain, scarring) are real, and the difference in clinical-athletic-rerupture outcomes is either marginal or non-existent, depending on how you interpret differences that are so small that they are statistically insignificant in studies with 150 participants.
All of that is just to clarify the record for other people. What YOU should know is that the vast majority of Ortho Surgeons refuse to repair “high” ATRs, as yours has explained to you. The good news is that following a good modern protocol from a good modern study that’s demonstrated excellent non-op results, should get you some excellent non-op results.
BTW, the usual reason to delay using a boot for 2 weeks is just to have an absorbent plaster-and-cotton cast or splint to absorb the blood and fluids that leak out of a surgical repair. The good studies did NOT delay the boot for their non-op patients. See (e.g.), bit.ly/UWOStudy for an intro to my fave recent study — and the entire text is available on this site, linked from the “ATR Rehab Protocols, Publications, Studies” page, which is near the top of the Main Page.
IMHO, the reasons to follow a fast, modern protocol in a boot — rather than “conservative casting” in a series of casts — are multiple and powerful, and probably even MORE powerful for the non-op route than the post-op. Basically, your life will be much more pleasant and better, you’ll spend less time at risk of a nasty fall on crutches, you may suffer less muscle and tissue atrophy, and most studies suggest that your clinical outcomes — including re-rupture risk — will be better!
Get a copy of your OS’s rehab protocol. If he wants you to go more slowly than the patients in the UWO study did, ask him why, and ask if he or your hospital has any solid evidence to suggest that their patients, on a slower protocol, experienced better clinical outcomes than the ones in that study. (If they DO have that evidence, they should publish it ASAP!!)
Good luck, and good healing.