Acute Achilles Tendon Ruptures: Efficacy of Conservative and Surgical (Percutaneous, Open) Treatment—A Randomized, Controlled, Clinical Trial

Manent, A.; López, L.F. Apodaca-García; Coromina, Héctor; Santamarı́a, Alejandro Thomas; Domínguez, Alejandro; Llorens, Natalia; Sales, Mônica Aline de Menezes Lima; Videla, Sebastián

doi:10.1053/j.jfas.2019.02.002

Cited by 47 publications

(62 citation statements)

References 35 publications

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“…†† There were 9 studies on open repair versus nonsurgical treatment, ‡‡ 1 study on MIS versus nonsurgical treatment, 56 and 1 study on open repair versus percutaneous repair versus nonsurgical treatment. 51 The mean QoE assessed by the modified Jadad scale was 5.6 ± 1.0 (range, 4.0-7.5). The rehabilitation program after surgery, as well as nonsurgical treatment protocols, varied widely from plaster casts to orthoses, as did the length of time required for patients to wear these supportive devices.…”

Section: Resultsmentioning

confidence: 94%

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates

et al. 2021

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Background: An acute Achilles tendon rupture (AATR) is a common injury. The controversy that has surrounded the optimal treatment options for AATRs warrants an updated meta-analysis that is comprehensive, accounts for loss to follow-up, and utilizes the now greater number of available studies for data pooling. Purpose: To meta-analyze the rates of all complications after the treatment of AATRs with a “best-case scenario” and “worst-case scenario” analysis for rerupture rates that assumes that all patients lost to follow-up did not or did experience a rerupture, respectively. Study Design: Systematic review and meta-analysis; Level of evidence, 1. Methods: Two authors performed a systematic review of the PubMed and Embase databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on February 17, 2020. The included studies were assessed in terms of the level of evidence, quality of evidence, and quality of the literature. A meta-analysis by fixed-effects models was performed if heterogeneity was low ( I2 < 25%) and by random-effects models if heterogeneity was moderate to high ( I2≥ 25%). Results: Surgical treatment was significantly favored over nonsurgical treatment for reruptures. Nonsurgical treatment was significantly favored over surgical treatment for complications other than reruptures, notably infections. Minimally invasive surgery was significantly favored over open repair for complications other than reruptures (no difference for reruptures), in particular for minor complications. Conclusion: This meta-analysis demonstrated that surgical treatment was superior to nonsurgical treatment in terms of reruptures. However, the number needed to treat analysis produced nonmeaningful values for all treatment options, except for surgical versus nonsurgical treatment and minimally invasive surgery versus open repair. No single treatment option was revealed to be profoundly favorable with respect to every complication. The results of this meta-analysis can guide clinicians and patients in their treatment decisions that should be made jointly and on a case-by-case basis.

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Section: Resultsmentioning

confidence: 94%

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates

et al. 2021

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“…Controversy surrounds the best treatment for acute Achilles tendon ruptures. Multiple treatments present good results in the short and long term, with none being superior to the others if followed by a full early rehabilitation protocol to support the patient's weight 28 .…”

Section: Discussionmentioning

confidence: 99%

Tensiometric evaluation of the effect of lowfrequency electric stimulation on healing Achilles tendons in rats

et al. 2020

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“…After initial title and abstract screening, 5593 citations were excluded and disagreement would be resolved by routine meeting of research group. During full text screening, a total of 97 citations not compliant to the criteria were excluded and 13 citations of studies were included in this meta-analysis eventually [11,[25][26][27][28][29][30][31][32][33][34][35][36]. The PRISMA owchart of this meta-analysis was displayed in Figure 1.…”

Section: Literature Searchingmentioning

confidence: 99%

“…There were 8 studies reported the result of return to sport among patients receiving ATR repair. Cetti et al [26] and Costa et al [28] reported the favorable outcome of surgical treatment in recovering the sport capacity of ATR patients compared with conservative management, while Manent et al [35] reported the opposite result favoring conservative treatment. Collectively, the overall result indicated that no signi cant difference between surgical and conservative treatment in sport capacity recovery (8 studies, 567 participants, Z=0.35, P=0.73, I 2 =75%, RR: 1.09, 95% CI: 0.67 to 1.77).…”

Section: Return To Sportmentioning

confidence: 99%

Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs

She

Teng

et al. 2020

Preprint

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Background Achilles tendon is the strongest tendon in human and frequently injured mainly in young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategy widely adopted in ATR patients but the consensus of optimal treatment strategy is still debated. We aimed at fully reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs).Method We comprehensively searched database of PubMed, Embase, Cochrane and ClinicalTrial.gov and retrieved all randomized controlled trials comparing surgical and conservative treatment on achilles tendon rupture for further analysis. Data extraction was performed by two independent reviewer and random effect model was adopted when I2 > 50%, with data presentation of risk ratio, risk difference or mean difference and 95% confidence interval. Results A total of 13 randomized control trials were included in this meta-analysis. Significant difference was observed in events of re-rupture, complication rate, adhesion to underlying tendon, sural nerve injury and superficial infection. For surgical treatment, significant reduction in re-rupture rate could be observed while complication rate was higher compared with conservative treatment. Conclusion Surgical treatment was revealed significance in reduction of re-rupture rate but associated with higher complication rate while conservative treatment showed similar outcomes with lower complication rate. Collectively, we recommend conservative treatment if patients’ status and expectation are suitable, but surgeon as well as physician’s discretion is also important in decision making.

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Acute Achilles Tendon Ruptures: Efficacy of Conservative and Surgical (Percutaneous, Open) Treatment—A Randomized, Controlled, Clinical Trial

Cited by 47 publications

References 35 publications

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates

Tensiometric evaluation of the effect of lowfrequency electric stimulation on healing Achilles tendons in rats

Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs

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