A 30-year-old athlete sustains complete Achilles tendon rupture confirmed on MRI. He is 28 years old, active, and wishes to return to sport. Comparing surgical versus conservative management, which statement is MOST supported by current evidence?

• A Conservative management is clearly superior for active young athletes due to lower overall complication rates
• B Surgical repair results in faster return to sport with identical re-rupture rates to conservative management
• C Both surgical and conservative treatments have identical outcomes and the choice is based on cost alone
• D Surgical repair has significantly lower re-rupture rate but higher wound complication rate compared to accelerated functional rehabilitation ✓

Explanation

Meta-analyses (including the UKSTAR trial data and Cochrane reviews) show that surgical repair of Achilles tendon rupture reduces re-rupture rates compared to conservative cast immobilisation alone (approximately 3–4% vs 8–10%). However, surgery carries higher risks of wound-related complications (wound infection, sural nerve damage, DVT, scar adhesions). When accelerated functional rehabilitation (early weight bearing and range-of-motion) is used non-operatively, re-rupture rates approach those of surgery, narrowing the advantage. Current guidelines recommend individual decision-making based on patient age, activity level, and risk tolerance.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.