Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture- operation or non-operation. The purpose of this meta-analysis was to identify and summarize the rando...Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture- operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures. Methods We searched multiple databases in English （including EMBASE, PubMed, and OVID） and in Chinese （including CNKI, WANFANG, and VIP）, as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software. Results Eight randomized controlled trials （RCTs） involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher （Z=3.33, P 〈0.01）. However, the moderate （Z--4.27, P 〈0.01） and minor （Z--5.59, P 〈0.01） complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter （Z=2.65, P 〈0.01）. The inability to return to previous level sporting rate and ankle joint decreased range of motion （ROM） rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups. Conclusions Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alter展开更多
Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic...Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmB ase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.展开更多
基金the National Natural Science Foundation of China
文摘Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture- operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures. Methods We searched multiple databases in English （including EMBASE, PubMed, and OVID） and in Chinese （including CNKI, WANFANG, and VIP）, as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software. Results Eight randomized controlled trials （RCTs） involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher （Z=3.33, P 〈0.01）. However, the moderate （Z--4.27, P 〈0.01） and minor （Z--5.59, P 〈0.01） complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter （Z=2.65, P 〈0.01）. The inability to return to previous level sporting rate and ankle joint decreased range of motion （ROM） rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups. Conclusions Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alter
文摘Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmB ase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.
