Even a “Complete Tendon Tear” that is Not Retracted May Be Treated Non-surgically
One small mistake – you made a sharp turn and flexed your ankle the wrong way, and now your Achilles tendon is ruptured. You might think you’re resigned to the fate of an invasive surgery and a boot or cast for the next couple months, but this might not be the case. So long as the Achilles tendon is not retracted (the ends of the tendon pull away from each other), it is likely that non-invasive, regenerative treatments like bone marrow concentrate containing your own live stem cells, or PRP could be able to help treat the tendon rupture. Read more about non-surgical Achilles tendon rupture treatment below.
Incidence of Achilles Tendon Rupture/Injury
An Achilles tendon rupture is a common injury that occurs most frequently in the younger adult population (around 30-45 years old) (1). Men are six times more likely than women to suffer from the injury, and active athletes are predominantly at risk as well (1,5). This population at risk makes sense, considering the popularity of professional men’s sports – young men playing high-intensity sports are prone to suddenly and violently over-flexing the foot, or having a moment of extreme stress on the Achilles tendon (1,5).
Symptoms:
- Popping sound in the heel after extreme stress applied on the ankle (5)
- Sharp, acute pain, like having been kicked in the calf (5)
- Cannot bend the affected foot downwards or stand on toes
How Does the Achilles Tendon Work?
The Achilles tendon is a long cord of tissue that connects muscles in the back of the calf to the ankle bone (5). This strong cord allows all of us to flex their foot, stand on their toes, rotate the ankle – the tendon plays a part in many foot movements. If the Achilles tendon is torn significantly, it can make walking difficult, and standing on the toes or flexing the foot should be very painful (5).
Achilles Surgery = Long Recovery Period
Achilles tendon tears undoubtedly cause a lot of pain, but many people fear them because of the long stretch of time it takes to recover and return to normal physical activities (2). Doctors frequently recommend surgery as a means to repair the Achilles tendon tear. But many patients wonder what Achilles tendon repair surgery is like – what will they experience during surgery, how long will it take post-operation to walk again, etc?
A patient that enters the operating room for Achilles tendon repair surgery will be placed under anesthesia for the entirety of the surgery (2). The surgeon would make an incision on the back of the patient’s calf and open up the skin in order to see the tendon below (2). If the Achilles tendon is entirely torn, it is likely that the surgeon will remove a tendon from a different part of the patient’s foot and graft it onto the Achilles to repair the tendon (2). Once this is complete, the surgeon will close the incision with stitches (2). Achilles tendon surgery is usually an outpatient procedure, so the patient will likely be able to return home the same day of the operation (2).
Unfortunately, the reason why it takes so long to recover from an Achilles tendon tear is just part of the body’s natural healing process (2). Muscles receive lots of nutrient-dense blood so they can work (and heal) properly, but tendons don’t receive as much blood flow (2). This means that injuries in tendons (like the Achilles) heal naturally slower than injuries elsewhere in the body. It is important to keep the foot immobilized for many weeks post-operation so that fully recovered walking is possible about three months after surgery (2). Full recovery may take up to a year.
About Non-Surgical BMC and/or PRP Procedures
In partial Achilles tendon tears or full tears that have not retracted, it is possible for a patient to choose regenerative care over surgery. Regenexx offers bone marrow concentrate (BMC) and platelet-rich plasma (PRP) procedures that can assist in healing a patient’s injury by using tissue samples taken from the patient’s own body.
During a Regenexx-SD bone marrow concentrate treatment, a specialist extracts bone marrow, rich in healing and repairing stem cells, from the patient’s hip bone (7). The specialist then re-injects the bone marrow concentrate into the patient’s injured area, and the stem cells from the bone marrow will help heal the torn tendon quicker than usual (7).
Platelet-rich plasma treatments, on the other hand, make use of healing growth factors contained in the blood to boost the body’s natural healing process (8). A physician extracts a patient’s blood, isolates the white blood cells and platelets, and re-injects this concentrated solution into the patient’s body using precise imaging guidance to pinpoint the problem area (8). Both BMC and PRP procedures are non-surgical regenerative care, and a physician would recommend a specific procedure for a patient based on the type of injury and other various factors.
Think of Rubber Bands to Understand How Partial Tears Can Be Treated Non-Surgically
Think of the Achilles tendon like a strong rubber band (3). It stretches and contracts, and it’s possible for the tendon to rip apart (3). A partial tear in the tendon would be like a small rip across the width of the rubber band – it is not whole anymore, but it’s not completely broken. A complete, non-retracted tear means that the tendon is ripped across the entire length, but there are still some fibers holding it together (3). Both incomplete tears and complete non-retracted tears are likely able to be treated with regenerative care (3). However, a complete retracted Achilles tendon tear is the most serious injury and likely needs surgery to repair (3). In this case, the tendon has completely ripped apart, and the pieces have snapped back and away from each other, just like a broken rubber band.
The dense tissues that make up the Achilles tendon naturally contain stem cells – repair cells that have the potential to become any type of cell (3). These stem cells are also plentiful in bone marrow and the tiny portion of blood that is platelets. When bone marrow or blood is extracted from elsewhere in the body and deposited in an injured area, the area is flooded with stem cells, meaning that the healing process can occur at a quicker rate of speed than normal (3). So, a BMC and PRP procedure would both be likely options to help repair a non-retracted Achilles tendon tear – it would depend on what a doctor recommends for each patient’s specific case.
Medical Clinical Trials Validate Non-Surgical Regenerative Treatments
A clinical trial published in 2020 performed a non-inferiority analysis on the efficacy of BMC treatment for Achilles tendon ruptures (9). Out of 422 total patients with ruptured Achilles tendons ages 18 to 71 years old, 363 of them received surgical treatment, and 59 were treated non-surgically (9). One year after the patients’ initial Achilles tendon ruptures, they were asked to evaluate the function of their Achilles tendon, or Achilles tendon rupture score (ATRS) (9). The higher the score, the better the Achilles tendon function. The mean ATRS for both groups, both surgically and non-surgically treated, one year post-injury, was 81.5 (9). This means that in terms of function of the Achilles tendon for patients treated for Achilles tendon rupture, there is no significant difference between those treated surgically and those treated non-surgically (9).
Potential Outcomes
See Regenexx Patient Outcomes Data here.
If you’ve suffered an injured achilles and now think a non-surgical PRP procedure may help, find out if you’re a Regenexx candidate?–Tap the “TALK TO AN EXPERT” BUTTON below.
SOURCES:
- https://www.sciencedirect.com/topics/medicine-and-dentistry/achilles-tendon-rupture
- https://utswmed.org/medblog/achilles-tendon-injuries-rehab/
- https://regenexx.com/blog/how-to-heal-a-torn-tendon-naturally/
- https://centenoschultz.com/prp-treatment-in-an-ironman-triathlete-with-achilles-tendinitis/
- https://www.mayoclinic.org/diseases-conditions/achilles-tendon-rupture/symptoms-causes/syc-20353234
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/achilles-tendon-repair-surgery
- https://regenexxpittsburgh.com/bone-marrow-concentrate-procedures/
- https://regenexxpittsburgh.com/platelet-rich-plasma/
- https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03320-3
