Intended for healthcare professionals


Surgery or conservative management for Achilles tendon rupture?

BMJ 2019; 364 doi: (Published 07 January 2019) Cite this as: BMJ 2019;364:k5344

Linked research

Operative treatment versus nonoperative treatment of Achilles tendon ruptures

Linked Opinion

Surgeons should know when not to operate

  1. Nicola Maffulli, professor, chair, and head of service1 2 3,
  2. Giuseppe M Peretti, professor and chair4
  1. 1Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
  2. 2Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London E1 4DG, UK
  3. 3Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK
  4. 4IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
  1. Correspondence to: N Maffulli n.maffulli{at}

Patients need better evidence on functional outcomes, including a return to sport

Acute ruptures of the Achilles tendon are common and can lead to major functional limitations, with noticeable loss of strength and endurance.1 Many such patients fail to resume sporting activities in the short term, and the injury produces ongoing problems even after 10 years.2 Modern management aims to promptly maximise function and minimise complications. Much of recent research has tried to determine the optimal methods of either surgical or non-surgical treatment using a randomised controlled trial study design, with the primary outcome in most of such studies being the prevention of re-ruptures. In a linked systematic review and meta-analysis, Ochen and colleagues (doi:10.1136/bmj.k5120) carefully analysed 29 studies in this specialty, including 19 observational and 10 randomised controlled trials.3

This rigorous work is to be commended. Ochen and colleagues’ investigation emphasises the importance of including high quality observational studies as …

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