Question:
Achilles Tendon rupture treatment
I am concerned with the treatment I am receiving for an achilles tendon rupture.
Whilst visiting friends in a different part of the country, I ruptured my achilles tendon and was subsequently seen in the local hospital by an orthopedic specialist. He recommended surgery because of my age (28) and because I partake in regular physical activity (5 times a week). I requested a transfer to my local hospital (London) to have the surgery for convenience reasons and notes were written by the consultant summarising findings (Achilles tendon rupture, ultrasound and surgery required).
I was seen 3 days after injury in local hospital by consultant. Within 2 minutes of meeting me, dismissed surgery (without the benefit of an ultrasound) and recommended non-surgical procedure; straight into plaster with re-positioning every 2 weeks.
I have had the benefit of discussing my injury with several sufferers who have all received surgery and I am now concerned for my long term recovery and risk of re-rupture.
Is this concern justified and should I seek a second opinion?
Asked by Hammerhance - 1 answer - 3 years 18 weeks ago
Yes. Your concern seems to me to be quite justified. At the very least, make sure you seek a second opinion.
You write that the first orthopaedic surgeon concluded that your Achilles tendon had ruptured. The term "ruptured tendon” may cover many different scenarios. A tendon may be severed completely or it may have sheared completely away from its attachment point on the bone. In that case, microsurgery is essential - the tendon is unlikely to reattach itself of its own accord however long one waits. The tendon, however, may be partly sheared away from the bone. If the amount of rupture is only slight, then, in principle, one might choose to adopt an attitude of watchful waiting combined with rest of the affected joint.
In principle, therefore, the modality of treatment of any ruptured tendon depends on the degree of rupture. I say in principle because many critics of modern medical practise believe that medical treatments should be almost always evidence based. (I say almost always because one can envisage a scenario where there is no obvious medical protocol to follow, and the patient is unwilling or unable to wait until there is a medical consensus about the best path to go down.)
In practise, like most surgeons, orthopaedic surgeons tend to continue to follow the procedures that they have learnt (and mastered) in the past, whether the hard, medical evidence supports that modality of treatment or not.
If you haven't done so already, I suggest that you start by going to Medscape and search for "ruptured Achilles tendon". See what Emedicine articles (part of the Medscape site) you can find.
Next, subscribe to PubMed and start searching for and reading the abstracts of the relevant medical literature. Of course, you may also have done all this already. My point is that you need to discover what the hard, medical evidence is to support rest and ultrasound versus surgery.
Finally, when you have concluded what the best treatment modality for your injury is (according to the hard evidence), try to find the most experienced, affordable orthopaedic surgeon you can who offers that modality.
Obviously here time is of the essence. In general, however, where treatment is less urgent, if one can afford the time and the cost, is willing to travel within the UK, the EU, the US and elsewhere if necessary, including Australia, Japan and China, to find the most experienced surgeon in the most effective modality of treatment, then in the long term the time and cost and inconvenience of this may well prove to be worthwhile.
Submitted 3 years 16 weeks ago by Colenso