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

Abstract

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.

Achilles' tendon rupture dancing the ‘Jerusalema’ – A case series

“…What is interesting from this study also is that of the eight studies that included ‘return to sport’ in their results the authors concluded that there was no difference in timeline between operative and non-operative approaches [18] .…”

Achilles Tendon Rip-Stop SpeedBridge Repair

“…A meta-analysis by Deng et al 7 demonstrated a 9.8% re-rupture rate in nonoperative treatment compared with a 3.7% rate following surgical intervention. She et al 8 also reports a significant reduction in re-rupture but a greater complication rate with surgical intervention including deep vein thrombosis, scar adhesion to underlying tendon, sural nerve injury and infection. Minimally invasive and traditional open Achilles repairs remain controversial as to which approach provides greater patient outcome.…”

Rates of Operative Management for Achilles Tendon Rupture Over the Last Decade and the Influence of Gender and Age

“…Overall, from 2010 through 2019, there was decline in operative repair of ATR (18.3%-12.3%, P < .0001); a trend demonstrated in several other studies as well. 1,3,5,18,19 A multicenter, randomized control by Willits et al 8 compared outcomes of ATRs who underwent nonoperative management with functional rehabilitation to operative treatment reporting that all measured outcomes of nonoperative management were acceptable and clinically similar to those of operative treatment while avoiding the complications associated with operative management. In addition, a meta-analysis of randomized trials comparing functional rehabilitation with early range of motion demonstrated that re-rupture rates were equal for operative and nonoperative patients, and the increased risk of having a complication other than a re-rupture in the operative group (risk difference 15.8%) may outweigh the increased risk of re-rupture in the nonoperative group if functional rehabilitation is not an option (risk difference 8.8%).…”

“…As more evidence supports nonoperative management with functional rehabilitation for ATRs, the trending characteristics of this evidence has not been elucidated. 3,5,6 While operative repair of the Achilles tendon may decrease the rate of re-rupture, it has also led to more complications compared with nonoperative management, which has been reported to have similar outcomes and less complications. 5,7,8 A study by Ochen et al 7 compared outcomes of operative versus nonoperative treatment of acute ATR demonstrating that operative treatment was associated with a significant reduction in re-rupture rate compared with nonoperative treatment.…”

“…3,5,6 While operative repair of the Achilles tendon may decrease the rate of re-rupture, it has also led to more complications compared with nonoperative management, which has been reported to have similar outcomes and less complications. 5,7,8 A study by Ochen et al 7 compared outcomes of operative versus nonoperative treatment of acute ATR demonstrating that operative treatment was associated with a significant reduction in re-rupture rate compared with nonoperative treatment. In addition, operative repair of ATR has also led to earlier return to work in select populations and better functional outcomes when evaluated by 2 different jump tests and 1 muscular endurance test.…”