Rerupture and wound complications following Achilles tendon repair: A systematic review

Abstract

Despite the relatively high frequency of Achilles ruptures, there is no general consensus on the optimal treatment method. A general trend toward more patients being treated nonoperatively has emerged recently with the advent of functional rehabilitation. However, much of the recent data on this subject has been highly variable. This systematic review focused on Achilles tendon rupture (ATR) treatment outcomes, with a focus on rerupture and complication rates. This systematic review specifically focused on articles regarding ATR treatment that also included rerupture and complication rates. Treatments were divided into three categories: open minimally invasive, open standard, and nonoperative. Bivariate analyses were performed to compare complication and rerupture rates among pairs of treatment options, as well as between early weight bearing versus immobilization. There was significantly higher complications for minimally invasive compared to nonoperative treatment (risk ratio [RR] = 4.4154; p < 0.05), lower complication rates for minimally invasive compared to open treatment (RR = 0.3231; p < 0.05), and higher complications for open standard compared to nonoperative treatment (RR = 5.6350; p < 0.001). There were significantly lower rerupture rates in minimally invasive compared to nonoperative treatment (RR = 0.4085; p < 0.001), a significantly lower rerupture rate in nonoperative treatment compared to open treatment (RR = 0.2282; p < 0.001), and no significant difference in rerupture rates when comparing minimally invasive to open standard treatment. We found that operative treatment is associated with fewer reruptures and more complications than a nonoperative approach. Minimally invasive surgery appears to be associated with a lower rate of complications than open operative treatment.

Achilles Tendon Ruptures: Limited Incision Repair

“…These circumstances confront orthopedic surgeons with a wide variety of patients’ needs and require individual treatment decisions. Conservative management avoids potential postsurgical complications, but it is associated with a higher rate of Achilles tendon rerupture 5 . Traditional open surgery, however, bears risk of surgical complications, such as surgical site infection 6 .…”

“…While repair strength analyses in biomechanical laboratories can provide valuable insights, the results observed in the clinical setting are decisive. An important body of research suggests that surgery, including minimally invasive procedures, is associated with a lower rate of rerupture compared with conservative treatment 5 . Comparing operative to nonoperative treatment, the assumption of fewer reruptures after operative treatment has been challenged, notably by Willitis and colleagues.…”

“…Conservative management avoids potential postsurgical complications, but it is associated with a higher rate of Achilles tendon rerupture. 5 Traditional open surgery, however, bears risk of surgical complications, such as surgical site infection. 6 In an attempt to improve surgical outcomes, diverse percutaneous approaches and techniques based on limited incision have been elaborated successfully since the 1970s.…”

“…An important body of research suggests that surgery, including minimally invasive procedures, is associated with a lower rate of rerupture compared with conservative treatment. 5 Comparing operative to nonoperative treatment, the assumption of fewer reruptures after operative treatment has been challenged, notably by Willitis and colleagues. However, the authors noted that their study was underpowered.…”