It’s Saturday night and ‘RockTape Richard’ phones me to say that he has done something to his Achilles tendon during a climbing competition. A few WhatsApp videos later and it looks like a full rupture!
The question is should Richard have surgery or undertake a non-surgical ‘conservative’ recovery plan?
Historically this would have been a question of age and activity levels. With older less active patients being recommended a conservative recovery plan that mainly utilises a boot to protect the tendon while it heals itself. Younger more active patients would recommended surgery due to the associated faster recovery and reduced re-rupture risk.
Interestingly the research often discussed return to full function but it’s important to remember that full function can be very different between individuals, i.e. athlete’s vs sedentary.
When we look closer at the surgery versus conservative treatment options, we can see that historical research, which largely focused on comparative re-rupture rates and surgical risks (like wound healing problems and sural nerve injury), is now less applicable. This is due to two key reasons:
1. Minimally invasive surgical techniques are now commonly used, significantly reducing the risk of nerve injury and infections.
2. There's increased awareness that the tendon gap between the ruptured ends is a crucial determinant of future re-rupture risk for conservative management. A gap of less than 5mm is associated with more favorable conservative outcomes.
So is surgery the best option for Richard?
It’s a bit too soon for any RockTape yet but we will be supporting Richards recovery from the very start. You can follow the recovery process with us here and over on @ThePhysioChannel (YouTube).
References: Yang, Z., Ge, Z., Zheng, J., Zhang, L., & Yang, Z. (2025). Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis. Journal of orthopaedic surgery and research, 20(1), 626. https://doi.org/10.1186/s13018-025-05990-y
Yang, X., Meng, H., Quan, Q., Peng, J., Lu, S., & Wang, A. (2018). Management of acute Achilles tendon ruptures: A review. Bone & joint research, 7(10), 561–569. https://doi.org/10.1302/2046-3758.710.BJR-2018-0004.R2
Deng, H., Cheng, X., Yang, Y., Fang, F., He, J., Tian, Y., Li, T., Xiao, Y., Feng, Y., Wang, P. and Chong, W., 2023. Rerupture outcome of conservative versus open repair versus minimally invasive repair of acute Achilles tendon ruptures: A systematic review and meta-analysis. PloS one, 18(5), p.e0285046.