Since the landmark randomized prospective trial comparing operative and non operative treatment of achilles tendon rupture there has been changes in the practice of achilles tendon repair. However the results may not be generalizable to the community from the teaching hospital environment that the study was performed in. The results may also not be generalizable to all work types (patients requiring repeating load or explosive strength) or sports types. If non operative treatment was working correctly then the revision rate would remain the same. This study explores the primary and revision achilles tendon repair rate in the Province of British Columbia by year. The fee guide in British Columbia tracks and reports billings for acute achilles tendon repair and chronic repair for each year. Data is available from 1998 to present. The relative rates are reported. Since 1997 the rate of acute achilles repair increased from 271 per year to a peak of 446 in 2008. The rate of acute repair then dropped to 120 in 2020. This corresponds to a rate of 54 per million population (pm), a peak of 89 pm, and down to a rate of 24 pm. The rate of delayed repair went from 29 in 1997 to 47 in 2008, and has increased to 124 per year in 2022 exceeding the rate of acute repair in 2020. This is a rate of 6 pm in 2007, 9 pm in 2008, and 25 pm in 2022. If the non-operative treatment was working within the population at large as expected then the rate of delayed repair would not have changed. Based on the change from 1997 to 2008 the number of delayed repairs would be in the region of 80 in 2022. There is 40 more delayed repairs than expected indicating that the non operative protocol is not being implemented as advocated in the RCT, or that the protocol is being adopted in patients not suitable for non operative treatment. Operative techniques for acute achilles repair have also changed to better repair strength and lower risks of wound complications potentially changing the applicability of the study. The application of non operative achilles tendon protocols across a Province likely leads to a higher rate of late repair. The need to look at population based statistics is required, and the treatment needs to apply to all sites and all patients. Newer Achilles repair techniques also need to be compared against the non operative protocol.
Younger et al. (Wed,) studied this question.