Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis.

Achilles tendon rupture is a common injury, and whether to treat it with surgery or with casting/bracing (conservative management) has long been debated. This review pooled data from 33 studies covering a very large number of patients to compare the two approaches across re-rupture, complications, return to sport, and functional scores. Surgery was linked to fewer re-ruptures and higher rates of returning to sport, but also came with more infections and nerve injuries than conservative treatment. There was no statistically significant difference in functional scores between the two approaches, and adding platelet-rich plasma injections did not appear to improve outcomes regardless of treatment type.

The main limitation is that the included studies likely varied substantially in design and quality, and the review draws on observational comparisons as well as trials, so the findings describe associations between treatment choice and outcomes rather than proof that surgery directly causes better healing in every case.

If you're facing a decision about how to treat a torn Achilles tendon, this review looked at the long-running question of whether surgery or non-surgical treatment with a cast or brace works better. Researchers combined results from a large number of studies comparing the two approaches. They found that people who had surgery were less likely to re-rupture the tendon and were more likely to return to sport, but they also had higher rates of infection and nerve injury compared to those treated conservatively.

When it came to overall tendon function scores, there was no clear difference between the two treatments. Adding platelet-rich plasma injections, a treatment sometimes used to speed healing, didn't appear to improve results either way.

The main caveat is that the underlying studies likely differed a lot in how they were conducted, so these patterns describe general trends across many patients rather than a guarantee of what any individual person would experience.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This meta-analysis speaks to the ongoing clinical question of whether operative or conservative management of acute Achilles tendon rupture yields better outcomes, pooling 33 studies and 35,896 patients. For re-rupture, surgery was associated with a lower risk (risk ratio 0.44, 95% CI 0.34-0.57), a roughly 3.52 percentage point reduction, and return to sport was higher in the surgical group (risk ratio 1.32, 95% CI 1.03-1.69).

These benefits were offset by higher infection rates (risk ratio 2.54), including both deep (risk ratio 1.91) and superficial (risk ratio 4.89) infection, and higher nerve injury rates (risk ratio 3.67) with surgery. Notably, ATRS functional scores did not differ significantly between groups (mean difference 7.02, 95% CI -1.35 to 15.38), and subgroup analysis found no benefit of platelet-rich plasma on re-rupture, return to sport, ATRS, or range of motion in either treatment arm, though this PRP subgroup evidence should be regarded as less certain than the headline comparison. The abstract does not specify the mix of study designs included, so the pooled estimates likely combine randomised and observational data with varying risk of bias, and heterogeneity across studies was addressed using random or fixed effects models depending on the I-squared value.

This informs shared decision-making conversations around trade-offs between re-rupture/return to sport and complication risk, but does not establish superiority of one approach for functional recovery or resolve variability in rehabilitation protocols across the underlying studies.