Surgical Repair of Achilles Tendon: No Better than No Surgery

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Patients often believe that surgery is necessary to fix their orthopedic problems. While these are some times that surgery is absolutely the best option, more times than not, surgery hasn’t been shown to help. A case in point is a torn Achilles tendon. The Achilles tendon often tears in middle aged patients playing racquet sports. If the tear doesn’t improve after a short trial of a walking boot to immobilize the foot and ankle, surgery is often recommended to sew the two ends of the tendon back together. However a study was just presented at AAOS that shows that surgery to repair the Achilles tendon isn’t better than no surgery. In the study, within 72 hours of injury, 97 patients were randomly assigned into either an Achilles tendon surgical repair group or two weeks of immobilizing the area and four weeks of wearing a hinged brace. There was no difference in outcome at 12 months after surgery between the groups. In fact the only difference was a >10% complication rate in the surgery group (one contracture of the tendon, two wound infections (one deep and one superficial), and two nerve problems). How about injections instead of surgery for Achilles tendon tears? Injecting steroid medications provides some short term relief in tendon injury, but longer lasting relief was seen with prolotherapy. Platelet rich plasma injections haven’t been shown to be better than saline injections, although injecting saline into the tendon amounts to a treatment similar to prolotherapy. In one animal study, the same day injection of stem cells helped repair the tendon. In summary, stay away from surgery if you have an Achilles tendon rupture, but injection into the tendon of prolotherapy or perhaps stem cells may be helpful.

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