Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs
Background: The Achilles tendon is the strongest tendon in human and is frequently injured, mainly in the young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major manage...
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2021-02-01
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doaj-751005f12aea466680eb41764eb2bc4f2021-02-18T15:20:57ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-02-01810.3389/fsurg.2021.607743607743Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTsGuorong She0Qiang Teng1Jieruo Li2Xiaofei Zheng3Lin Chen4Huige Hou5Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, ChinaDepartment of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, ChinaDepartment of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, ChinaDepartment of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, ChinaDrug Clinical Trial Institution, First Affiliated Hospital of Jinan University, Guangzhou, ChinaDepartment of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, ChinaBackground: The Achilles tendon is the strongest tendon in human and is frequently injured, mainly in the young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategies widely adopted in ATR patients, but the consensus of the optimal treatment strategy is still debated. We aimed at thoroughly reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs).Method: We comprehensively searched PubMed, Embase, Cochrane, and ClinicalTrial.gov and retrieved all RCTs comparing surgical and conservative treatment on ATR for further analysis. Two independent reviewers performed data extraction and random effect model was adopted when I2 > 50%, with data presentation of risk ratio, risk difference, or mean difference and 95% confidence interval.Results: A total of 13 RCTs were included in this meta-analysis. A significant difference was observed in re-rupture, complication rate, adhesion to the underlying tendon, sural nerve injury, and superficial infection. A substantial reduction in re-rupture rate could be observed for surgical treatment while the complication rate was higher compared with conservative treatment.Conclusion: Surgical treatment revealed significance in reducing the re-rupture rate but was associated with a higher complication rate, while conservative treatment showed similar outcomes with a lower complication rate. Collectively, we recommend conservative treatment if patients' status and expectations are suitable, but surgeon and physician discretion is also crucial in decision making.https://www.frontiersin.org/articles/10.3389/fsurg.2021.607743/fullAchilles tendon rupturesurgeryconservativemeta-analysisclinical outcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Guorong She Qiang Teng Jieruo Li Xiaofei Zheng Lin Chen Huige Hou |
spellingShingle |
Guorong She Qiang Teng Jieruo Li Xiaofei Zheng Lin Chen Huige Hou Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs Frontiers in Surgery Achilles tendon rupture surgery conservative meta-analysis clinical outcome |
author_facet |
Guorong She Qiang Teng Jieruo Li Xiaofei Zheng Lin Chen Huige Hou |
author_sort |
Guorong She |
title |
Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs |
title_short |
Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs |
title_full |
Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs |
title_fullStr |
Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs |
title_full_unstemmed |
Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs |
title_sort |
comparing surgical and conservative treatment on achilles tendon rupture: a comprehensive meta-analysis of rcts |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Surgery |
issn |
2296-875X |
publishDate |
2021-02-01 |
description |
Background: The Achilles tendon is the strongest tendon in human and is frequently injured, mainly in the young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategies widely adopted in ATR patients, but the consensus of the optimal treatment strategy is still debated. We aimed at thoroughly reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs).Method: We comprehensively searched PubMed, Embase, Cochrane, and ClinicalTrial.gov and retrieved all RCTs comparing surgical and conservative treatment on ATR for further analysis. Two independent reviewers performed data extraction and random effect model was adopted when I2 > 50%, with data presentation of risk ratio, risk difference, or mean difference and 95% confidence interval.Results: A total of 13 RCTs were included in this meta-analysis. A significant difference was observed in re-rupture, complication rate, adhesion to the underlying tendon, sural nerve injury, and superficial infection. A substantial reduction in re-rupture rate could be observed for surgical treatment while the complication rate was higher compared with conservative treatment.Conclusion: Surgical treatment revealed significance in reducing the re-rupture rate but was associated with a higher complication rate, while conservative treatment showed similar outcomes with a lower complication rate. Collectively, we recommend conservative treatment if patients' status and expectations are suitable, but surgeon and physician discretion is also crucial in decision making. |
topic |
Achilles tendon rupture surgery conservative meta-analysis clinical outcome |
url |
https://www.frontiersin.org/articles/10.3389/fsurg.2021.607743/full |
work_keys_str_mv |
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