SURGICAL VS. CONSERVATIVE MANAGEMENT OF ACUTE ACHILLES TENDON RUPTURE: A COMPARATIVE ANALYSIS OF FUNCTIONAL OUTCOMES AND RE-RUPTURE RATES
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5007Keywords:
Achilles Tendon Rupture, Functional Outcomes, Re-Rupture Rate, Conservative Treatment, Surgical Management, RehabilitationAbstract
Background: Acute Achilles tendon rupture (AATR) is a frequent injury among physically active adults. Despite extensive research, the optimal management strategy (surgical versus conservative) remains controversial due to differences in re-rupture rates, complication profiles, rehabilitation protocols and patient-specific factors. While surgery has traditionally been favored for reducing re-rupture risk, advances in early functional rehabilitation have strengthened support for nonoperative treatment.
Objective: This study aims to compare surgical and conservative management of AATR with respect to re-rupture rates, functional outcomes, complications and time to return to activity.
Methods: A narrative comparative review was conducted using PubMed and PMC databases, including randomized controlled trials, cohort studies and meta-analyses published up to December 2025. Studies involving adult patients with AATR and reporting functional outcomes, complication rates and rehabilitation protocols with a minimum follow-up of approximately six months were included. Cadaveric and non-comparative studies were excluded.
Results: Surgical treatment was associated with a lower re-rupture rate (3.7%) compared with conservative management (9.8%), but demonstrated higher rates of complications, particularly wound infection and nerve injury. Minimally invasive surgical techniques reduced complication risk while preserving efficacy. Functional outcomes such as range of motion, return to work or sport and patient-reported scores (e.g., ATRS) were comparable between treatment modalities when early mobilization and structured rehabilitation protocols were implemented.
Conclusions: Surgical treatment provides a modest advantage in preventing re-rupture but carries an increased risk of complications. Conservative management with functional rehabilitation yields similar long-term functional outcomes. Treatment decisions should be individualized, incorporating patient characteristics, activity level and preferences. Further high-quality studies are needed to optimize rehabilitation strategies and refine treatment selection criteria.
References
Fan, L., Hu, Y., Zhou, L., & Fu, W. (2024). Surgical vs. nonoperative treatment for acute Achilles’ tendon rupture: A meta-analysis of randomized controlled trials. Frontiers in Surgery, 11, 1483584. https://doi.org/10.3389/fsurg.2024.1483584
Keating, J. F., & Will, E. M. (2011). Operative versus non-operative treatment of acute rupture of tendo Achillis: A prospective randomised evaluation of functional outcome. The Journal of Bone and Joint Surgery. British Volume, 93(8), 1071–1078. https://doi.org/10.1302/0301-620X.93B8.25998
Yammine, K., & Assi, C. (2017). Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies. Foot, 30, 13–20. https://doi.org/10.1016/j.foot.2016.09.006
Abduljawad, S. M., Almonla, Y., Bin Sahl, A., Balvinder, R., & Pillai, A. (2024). Factors that determine the outcomes of surgical versus conservative management in Achilles tendon ruptures: A retrospective cohort study. Cureus, 16(11), e74338. https://doi.org/10.7759/cureus.74338
Myhrvold, S. B., Brouwer, E. F., Andresen, T. K. M., Rydevik, K., Amundsen, M., Grün, W., Butt, F., Valberg, M., Ulstein, S., & Hoelsbrekken, S. E. (2022). Nonoperative or surgical treatment of acute Achilles’ tendon rupture. The New England Journal of Medicine, 386(15), 1409–1420. https://doi.org/10.1056/NEJMoa2108447
Glazebrook, M., & Rubinger, D. (2019). Functional rehabilitation for nonsurgical treatment of acute Achilles tendon rupture. Foot and Ankle Clinics, 24(3), 387–398. https://doi.org/10.1016/j.fcl.2019.05.001
Holm, C., Kjaer, M., & Eliasson, P. (2015). Achilles tendon rupture—Treatment and complications: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 25(1), e1–e10. https://doi.org/10.1111/sms.12209
Deng, S., Sun, Z., Zhang, C., Chen, G., & Li, J. (2017). Surgical treatment versus conservative management for acute Achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials. The Journal of Foot and Ankle Surgery, 56(6), 1236–1243. https://doi.org/10.1053/j.jfas.2017.05.036
Willits, K., Amendola, A., Bryant, D., Mohtadi, N. G., Giffin, J. R., Fowler, P., Kean, C. O., & Kirkley, A. (2010). Operative versus nonoperative treatment of acute Achilles tendon ruptures: A multicenter randomized trial using accelerated functional rehabilitation. The Journal of Bone and Joint Surgery. American Volume, 92(17), 2767–2775. https://doi.org/10.2106/JBJS.I.01401
Manent, A., López, L., Corominas, H., Santamaría, A., Domínguez, A., Llorens, N., Sales, M., & Videla, S. (2019). Acute Achilles tendon ruptures: Efficacy of conservative and surgical (percutaneous, open) treatment—A randomized, controlled, clinical trial. The Journal of Foot and Ankle Surgery, 58(6), 1229–1234. https://doi.org/10.1053/j.jfas.2019.02.002
Aurich, M., Becherer, L., & Rammelt, S. (2024). Operative oder konservative Behandlung der akuten Achillessehnenruptur: Was sagt die aktuelle Literatur? [Surgical or non-operative treatment of acute Achilles tendon rupture: What does the current literature say?]. Orthopadie, 53(10), 740–748. https://doi.org/10.1007/s00132-024-04556-w
Yang, Z., Ge, Z., Zheng, J., et al. (2025). Surgical treatment versus conservative management for acute Achilles tendon rupture: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 20, 626. https://doi.org/10.1186/s13018-025-05990-y
Wijaya, N., Putri, N., Mahadhana, S., Dharmayuda, C., Aryana, I., Dusak, I., & Subawa, I. W. (2025). Management of Achilles tendon rupture: Surgical versus conservative method. Genij Ortopedii, 31(5), 666–677. https://doi.org/10.18019/1028-4427-2025-31-5-666-677
Kürüm, H., Tosun, H. B., Aydemir, F., Ayas, O., Kürüm, K. O., & İpekten, F. (2025). Surgical outcomes in patients with Achilles tendon rupture—A retrospective study. PeerJ, 13, e18890. https://doi.org/10.7717/peerj.18890
Santana, L., Rodrigues, R., N., & Cruz, J. (2025). Conservative treatment of Achilles tendon rupture: A systematic review comparative with surgical treatment. Orthopedic Reviews, 17, 143568. https://doi.org/10.52965/001c.143568
Alghamdi, A., Alzahrani, F., Alghamdi, A., Alghamdi, K., Alzahrani, A., Alsharari, M., Alghamdi, H., Alghamdi, A., & Alghamdi, M. (2025). Comparing outcomes of surgical and nonsurgical management for Achilles tendon ruptures: A systematic review and meta-analysis. International Journal of Physical Therapy Research & Practice. https://doi.org/10.62464/ijoprp.v4i6.116
Seow, D., Islam, W., Randall, G., Azam, M., Duenes, M., Hui, J., Pearce, C., & Kennedy, J. (2023). Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute Achilles tendon ruptures: A systematic review of overlapping meta-analyses. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 3528–3540. https://doi.org/10.1007/s00167-023-07411-1
De Valderrama, S., Martínez, B., & Herrando, L. (2025). Achilles tendon rupture treatment systematic review and meta-analysis. Foot & Ankle Orthopaedics, 10. https://doi.org/10.1177/24730114251327219
Kosiol, J., Keiler, A., Loizides, A., Gruber, H., Henninger, B., Bölderl, A., & Gruber, L. (2022). Operative versus conservative treatment of acute Achilles tendon ruptures: Preliminary results of clinical outcome, kinematic MRI and contrast-enhanced ultrasound. Archives of Orthopaedic and Trauma Surgery, 143, 2455–2465. https://doi.org/10.1007/s00402-022-04457-7
Pisano, A., Boxler, M., Gambuti, E., Falco, F., Trierweiler, M., Vinci, A., Bardhi, D., D’Alò, G., Malerba, R., Grassi, A., Ingravalle, F., & Maurici, M. (2025). Open surgical repair as gold standard for acute Achilles tendon ruptures: Systematic review and network meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. https://doi.org/10.1002/ksa.12686
Kilkenny, C., Daly, G., Irwin, S., Doyle, T., Saldanha, A., Alghawas, L., McGoldrick, N., & Quinlan, J. (2025). Long-term outcomes following surgical intervention for Achilles tendon rupture: A systematic review with a minimum five-year follow-up. Cureus, 17. https://doi.org/10.7759/cureus.77614
Ochen, Y., Beks, R., Van Heijl, M., Hietbrink, F., Leenen, L., Van Der Velde, D., Heng, M., Van Der Meijden, O., Groenwold, R., & Houwert, M. (2019). Operative treatment versus nonoperative treatment of Achilles tendon ruptures: Systematic review and meta-analysis. The BMJ, 364. https://doi.org/10.1136/bmj.k5120
Bak, B., Seow, D., Teo, Y., Hasan, M., & Pearce, C. (2024). Return to play and functional outcomes following treatment of acute Achilles tendon ruptures: A systematic review and meta-analysis. Foot & Ankle Orthopaedics, 9. https://doi.org/10.1053/j.jfas.2023.12.008
Xu, S., Xiao, J., Li, Y., Liu, E., Qin, Y., & Shen, X. (2025). Operative versus nonoperative management of acute Achilles tendon rupture: A systematic review and meta-analysis of clinical outcomes from randomized controlled trials. Annals of Medicine, 57. https://doi.org/10.1080/07853890.2025.2537349
Ilyas, M., Khalid, Z., Rashid, U., Irfan, A., Abubakar, M., & Nazir, F. (2023). Comparative effectiveness of surgical vs. conservative treatment in managing acute Achilles tendon ruptures. Pakistan Journal of Medical & Health Sciences. https://doi.org/10.53350/pjmhs20231710211
Delmastro, E., Colace, S., Longo, U., D’Hooghe, P., Marangon, A., Galasso, O., Gasparini, G., & Mercurio, M. (2025). Revision surgery for Achilles tendon rupture: A comprehensive review of treatment options, outcomes, and complications and the role of artificial intelligence. Medicina, 61. https://doi.org/10.3390/medicina61091684
Saggar, R., Mullen, J., Mangone, P., & Hogan, M. (2025). Achilles tendon ruptures: Nonsurgical versus surgical treatment. Arthroscopy, 41(5), 1252–1254. https://doi.org/10.1016/j.arthro.2025.02.002
Cho, T., Nair, A., Sohn, E., Mustapha, R., Shendge, S., & Liu, J. (2025). Comparison of open, percutaneous, or mini-open repair in the treatment of Achilles tendon ruptures: A systematic review and meta-analysis based on comparison studies. Annals of Joint, 10. https://doi.org/10.21037/aoj-24-53
Huz, S., Kononenko, S., Pelypenko, O., & Kovaliov, O. (2025). Comparative analysis of surgical treatment outcomes in patients with Achilles tendon rupture and comorbid pathology. Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії. https://doi.org/10.31718/2077-1096.25.3.17
Wen, J., Shehabat, M., Razick, D., Abed, I., Muttalib, Z., Thomas, V., Taguinod, I., Nadora, D., Kou, M., Kondle, S., & Lehnert, B. (2025). Outcomes of the mini-open technique for Achilles tendon repair: An updated systematic review. Cureus, 17. https://doi.org/10.7759/cureus.81718
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Weronika Justyna Skoneczna, Jakub Jan Woźniak, Lidia Mądrzak
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
