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Int J Surg. 2016 Dec;36(Pt A):305-311. doi: 10.1016/j.ijsu.2016.11.014. Epub 2016 Nov 10.

Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses.

Author information

1
Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
2
Department of Orthopaedics, The 306th Hospital of People's Liberation Army, No. 9, Anxiangbeili, Beijing, China. Electronic address: jiazhiwei@139.com.
3
Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China. Electronic address: ruandikengh@163.com.

Abstract

OBJECTIVE:

There is discordance in the results from meta-analyses on surgical versus non-surgical treatment for acute Achilles tendon rupture. We systematically reviewed the overlapping meta-analyses on this topic to provide information that will be helpful to decision makers when selecting treatments based on the current best available evidence.

METHODS:

We comprehensively searched multiple databases for systematic reviews that compared surgical and non-surgical treatments for acute Achilles tendon rupture. We only included meta-analyses that comprised randomized controlled trials (RCTs). The methodological quality and extracted data were assessed. The meta-analysis that offered the best evidence was ascertained with the Jadad decision algorithm.

RESULTS:

Nine meta-analyses were included in our study and all of them included RCTs with Level-II evidence. Assessment of Multiple Systematic Reviews (AMSTAR) scores ranged from 5 to 10 (median 7). The Jadad decision algorithm was used to select a high-quality meta-analysis with more RCTs. The results from this study showed that when functional rehabilitation was used, non-surgical intervention was similar to surgical treatment regarding the incidence of range of motion, rerupture, calf circumference and functional outcomes, and the incidence of other complications was reduced. Non-surgical intervention significantly increased the rerupture rate if functional rehabilitation was not considered.

CONCLUSIONS:

The findings of meta-analyses regarding surgical versus non-surgical treatment for acute Achilles tendon rupture are inconsistent. According to this systematic review of overlapping meta-analyses, the current best available evidence suggests that centers offering functional rehabilitation may prefer non-surgical intervention. Surgical treatment may be preferred at centers that do not have functional rehabilitation.

KEYWORDS:

Achilles tendon rupture; Meta-analysis; Non-surgical; Surgical

PMID:
27838385
DOI:
10.1016/j.ijsu.2016.11.014
[Indexed for MEDLINE]
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