Efficacy of Surgical Management versus Conservative Management to Decrease the Incidence of Re-Rupture in Adult Patients with Achilles Tendon Rupture: A Systematic Review and Meta-Analysis

Abstract

Purpose. To determine whether surgical management is more effective than conservative management in reducing the incidence of re rupture in adult patients with Achilles’ tendon rupture. Materials and methods. A systematic review and meta-analysis was conducted, including ten clinical trials that compared surgical management versus conservative management. Data were extracted and analyzed to compare the efficacy of both approaches in the incidence of re-rupture of the Achilles tendon and secondary outcomes: short-and long-term functional outcome, presence of chronic pain, and adverse effects (deep vein thrombosis and pulmonary embolism). Results. The incidence of re rupture in the surgical management group was 65% lower than in the conservative management group (RR 0.35; 95%CI 0.20-0.62). As for short-term functional outcome, there were no statistically significant results (MD 1.22; 95%CI -1.62 to 4.05). The mean long-term functional outcome in the surgical management group was 0.72 standard deviations higher (MD 0.72; 95%CI 0.37-1.08). The probability of developing chronic pain in the surgical management group is 68% higher than in the conservative management group (RR 1.68; 95%CI 1.09-2.59). The probability of developing pulmonary embolism and developing deep vein thrombosis did not have statistically significant results (RR 2.75; 95%CI 0.31-24.75) (RR 0.71; 95%CI 0.23-2.23). Conclusions. Surgical management is more effective in reducing the incidence of Achilles tendon re-rupture, presents a lower long-term functional result. However, increase the probability of presenting chronic pain compared with conservative management.