CME OnDemand: 2022 AOFAS Annual Meeting-Treatment of Acute Achilles Tendon Ruptures: A Systematic Review of Overlapping Meta-Analyses

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This study aims to systematically review and present the current meta-analyses on the treatment of acute Achilles tendon rupture (AATR). A total of 21 meta-analyses were included in the study. The results showed that operative repair had lower rates of re-rupture compared to conservative treatment. However, there was conflicting information on whether early functional rehabilitation reduced the difference between the two treatments. Operative treatment had a higher rate of wound complications, although the rates of deep wound infections remain to be determined. Percutaneous repair had similar re-rupture rates compared to open surgery, but rates of other complications, including wound infections, were diminished.<br /><br />The study used two independent reviewers to search PubMed and Embase based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence (LoE) was evaluated using published criteria by The Journal of Bone and Joint Surgery, and the quality of evidence (QoE) was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Statistical analysis was performed using R software, and p-values less than 0.05 were considered statistically significant.<br /><br />Overall, the study concludes that operative repair reduces the rate of re-rupture in AATR compared to conservative treatment. However, there are differences in methodologies among the meta-analyses, leading to conflicting data. The study highlights the need for further research to determine the optimal treatment approach and to better understand the rates of wound complications, especially deep wound infections, associated with operative repair.

Asset Subtitle

Dexter Seow, MB BCh BAO, Hugo A. Ubillus, MD, Mohammad T. Azam, BS, Matthew B. Weiss, BS, Arianna L. Gianakos, DO, Youichi Yasui, MD, Christopher J. Pearce, MFSEM(UK), MB ChB, FRCS(Tr&Orth), John G. Kennedy, MD, FRCS(Orth)

Keywords

acute Achilles tendon rupture

meta-analyses

operative repair

conservative treatment

re-rupture rates

early functional rehabilitation

wound complications

deep wound infections

percutaneous repair

open surgery