Achilles Tendon Ruptures: To Repair Or Not To Repair? Let's Talk Evidence.
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- Опубліковано 7 вер 2024
- In June, one of the NBA's transformative stars, Kevin Durant, underwent surgery for a ruptured right Achilles tendon. Will he be the same player after he returns? The future is uncertain. However the bigger question is, should he have had the surgery in the first place?
In our latest podcast, Dr. Mohit Bhandari and Dr. Brad Petrisor sit down to discuss the latest evidence around Achilles tendon ruptures and whether to repair or not to repair.
The ACE Report discussed is:
Operative treatment vs. non-operative treatment in Achilles tendon ruptures
www.myorthoevi...
I've got a partial rupture, with late diagnosis. Because I exercise the surgeon (rightly) says I'll need surgery. But what really shocked me was the MRI. It shows hardly any tendon remaining. But palpating the tendon - with the ball of the foot under slight load, or no load - the tendon feels round and continuous the whole way. I can only assume tendinopathy around the tendon is what I feel, and the torn tendon is in the middle of that, and the MRI sees it.
@craigross341
So did you get surgery?
How are you doing now?
Thanks for sharing this really great discussion! As someone who is having surgery to repair an Achilles‘ tendon tomorrow morning, I’m watching all sorts of related videos. It seems to me that this paper is only comparing operative vs non operative treatment using the two dimensions of rerupture rate and complications, and that there are many other independent and important dimensions, (length of recovery, strength/range of motion after 1 year for example) that probably also went into Durant’s decision (and should go into everyone else’s decision too). Are there studies you know of that try to take these into account, or factor in patients age or overall fitness?
Thanks for recording this episode. Appreciate the discussion on this topic!
What id really want to know, is a meta analysis regarding recover rates on a rerupture. one with a conservative rerupture followed by an operable repair of the rerupture. vs an operable rerupture followed by a second operable repair.
That is the sole reason I chose the conservative route. I went with the thought process of the rerupture rate risk didderence being basically negligible. yes the surgery infection risk. but say worst case scenario I do rerupture it down the road for a second time and require surgery for repair. it would be my first surgery vs having a second surgery on the same spot. My decision came down to not burning the surgical bridge until I needed to cross it.
If that makes sense?
yes pretty logical
My surgical idiot bridge insisted on me getting a heel plate surgery, very expensive.. when he couldn't show me why on the x-ray and ct. (there was slight fracture line and a 2 small fragments on surface only.. he admitted, yet still insisted.. so I burned the bridge. Didn't even know I have an Achilles rupture full tear until week 4.. welcome to scam hospitals Canada
Let’s say athletes prefer surgical repair over NARPs. Let’s also say that athletes’ more dynamic activities contribute to higher re-rupture. It would heavily screw the data for treating highly active patients. I’m a Decathlete who wasn’t given an option based on this study. Three weeks after the injury I’m getting more opinions.
Geez i need help im dealing with this right now I don't know whether to get surgery or not I ruptured my achilles tendon
What did u choose?
@@cloudyw1thachanceofra1nbow surgery
@@Zone-mc2tp how is it going?
@@cloudyw1thachanceofra1nbow good walking with no boot start therapy tomorrow
@@Zone-mc2tp Godspeed!
I had to wait 10 days to see orthopedics. He didn't give me surgery option. After the fact, I've seen other Dr's say that if you don't get in a cast/boot within a couple of days you need surgery, so now I'm worried my achillies isn't going to heal correctly.
You should get a second opinion maybe if possible. I got lucky got had it splinted within hours at the ER and the first orthopedist that took my insurance had an opening that day so from injury to seeing a doctor and being in a cast it was around 18 to 19 hours.
Doctour just straight up said he recommends non surgical but he won't push me one way or the other. All I had was a x-ray. I didn't get told the lengths or whatever of the rupture. I didn't go in for a second opinion but I'm sure it'll be fine. For you depending on what you were doing in those 10 days it might be okay. If you weren't active or moving about had it elevated.
I missed that period too of putting in that ballerina position. I’m a month in now, but I’ve been wearing a walking boot for 3 weeks. I’m still working…I can afford to miss a month of work…I do have time off/sick leave but it isn’t enough to cover my bills without overtime or my side job. I don’t do to much on my feet for work anyway but I’m just worried I’ll forever have a limp and worry about it tearing
How did it work out? I’m in the same position
Summary: No real benefit of information from the study that was reviewed and it's entirely based on the patient.
I dunno, is it just me, or does sometimes methodology get in the way more than it helps? Lets say research methodologies didn't exist, we're way back in time or something, and I wanted to out the answer to the question to op or not. I'd go around asking as many people as I could find and see what route they took, and what complications arose. Isn't this simple survey a sufficient enough answer to the question? Did you get surgery or not, did you reruptue or not, did you get infection or not. My understanding is that our devised methodologies for current research is primarily, but not solely, to control/understand variables/confounding variables. And for something like this, there are probably thousands of those. We don't have anywhere near the level of detail in the literature currently. Just scattered and sparse data sets here and there. But when we want to look into our overall and general risk of our decision, asking a city of 15k (the pooled sample size in the meta-analysis) those survey questions above, I would, myself, be more than satisfied with assessing my own risk for which path to take. Which I have. I've chosen non-op. The details are the tricky part (nutrition, protocol, etc, etc), and everyone, the most prestigious doctors included, are making educated guesses, which are very, very often conflicting. And they have their own very reasonable sounding ideas for why they choose one thing over another, which is often not based on any research. So there are two sides of the pendulum which exist in even one of the most rigorous fields of science, health; one side where there is an over reliance on methodology to assess a simple question, and another side where there it is all up to the individual (doctor's) knowledge/intuition. The middle ground is openness. My doc would say "ya know, I don't know about that, sounds like you may actually know more about it". What a wonderful relief to feel the lack of ego! Anyway, I'm ranting now...
Hey Chad, I rupture my Achilles 4 days ago and I’ve been in a walking boot for 3 days now. I took an MRI this week and seeing the doctor next week to review the results and talk about going operational or non op. Im not sure which route to go. Can you tell me your experience with going the non op route and how you’re doing? Any tips and tricks for the early stages weeks 1-2?
? = question mark
Surgery is probably *much* better on re-rupture, because those most likely to be active will be pushed to surgery. The cohort of conservative treatment patients will be full of those who told the doctor they do nothing but watch TV and eat toast. All the high jumpers get surgery, *and* generate half a ton of force on take off.
Athletes are going to rehab like professional
Average Joe's are gonna drink milk and chill out. Then rerupture in Sunday league basketball