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Rerupture Rate after Early Weightbearing in Operative Versus Conservative Treatment of Achilles Tendon Ruptures: A Meta-analysis

      Abstract

      Whether Achilles tendon rupture benefits from surgery or conservative treatment remains controversial. Moreover, the outcome can be influenced by the rehabilitation protocol. The goal of the present meta-analysis was to compare the rerupture rate after surgical repair of the Achilles tendon followed by weightbearing within 4 weeks versus conservative treatment with weightbearing within 4 weeks. In addition, a secondary analysis was performed to compare the rerupture rates in patients who started weightbearing after 4 weeks. Seven randomized controlled trials published from 2001 to 2012, with 576 adult patients, were included. The primary outcome measure was the rerupture rate. The secondary outcomes were minor and major complications other than rerupture. In the early weightbearing group, 7 of 182 operatively treated patients (4%) experienced rerupture versus 21 of 176 of the conservatively treated patients (12%). A secondary analysis of the patients treated with late weightbearing showed a rerupture rate of 6% (7 of 108) for operatively treated patients versus 10% (11 of 110) for conservatively treated patients. The differences concerning the rerupture rate in both groups were not statistically significant. No differences were found in the occurrence of minor or major complications after early weightbearing in both patient groups. In conclusion, we found no difference in the rerupture rate between the surgically and nonsurgically treated patients followed by early weightbearing. Weightbearing after 4 weeks also resulted in no differences in the rupture rate in the surgical versus conservatively treated patients. However, surgical treatment was associated with a twofold greater complication rate than conservative treatment.

      Level of Clinical Evidence

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      References

        • Khan R.J.
        • Fick D.
        • Keogh A.
        • Crawford J.
        • Brammar T.
        • Parker M.
        Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials.
        J Bone Joint Surg Am. 2005; 87: 2202-2210
        • Khan R.J.
        • Carey Smith R.L.
        Surgical interventions for treating acute Achilles tendon ruptures.
        Cochrane Database Syst Rev. 2010; 9: CD003674
        • Bhandari M.
        • Guyatt G.H.
        • Siddiqui F.
        • Morrow F.
        • Busse J.
        • Leighton R.K.
        • Sprague S.
        • Schemitsch E.H.
        Treatment of acute Achilles tendon ruptures: a systematic overview and meta-analysis.
        Clin Orthop Relat Res. 2002; 400: 190-200
        • Wilkins R.
        • Bisson L.J.
        Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials.
        Am J Sports Med. 2012; 40: 2154
        • Andersson T.
        • Eliasson P.
        • Aspenberg P.
        Tissue memory in healing tendons: short loading episodes stimulate healing.
        J Appl Physiol. 2009; 107: 417-421
        • Enwemeka C.S.
        • Spielholz N.I.
        • Nelson A.J.
        The effect of early functional activities on experimentally tenotomized Achilles tendons in rats.
        Am J Phys Med Rehabil. 1988; 67: 264-269
        • Krapf D.
        • Kaipel M.
        • Majewski M.
        Structural and biomechanical characteristics after early mobilization in an Achilles tendon rupture model: operative versus nonoperative treatment.
        Orthopaedics. 2012; 35: 1383-1388
        • Palmes D.
        • Spiegel H.U.
        • Schneider T.O.
        • Langer M.
        • Stratmann U.
        • Budny T.
        • Probst A.
        Achilles tendon healing: long-term biomechanical effects of postoperative mobilization and immobilization in a new mouse model.
        J Orthop Res. 2002; 20: 939-946
        • Metz R.
        • Verleisdonk E.J.
        • van der Heijden G.J.
        • Clevers G.J.
        • Hammacher E.R.
        • Verhofstad M.H.
        • van der Werken C.
        Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weight bearing—a randomized controlled trial.
        Am J Sports Med. 2008; 36: 1688-1694
        • Kangas J.
        • Pajala A.
        • Siira P.
        • Hämäläinen M.
        • Leppilahti J.
        Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study.
        J Trauma. 2003; 54: 1171-1180
        • Suchak A.A.
        • Bostick G.P.
        • Beaupré L.A.
        • Durand D.C.
        • Jomha N.M.
        The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon.
        J Bone Joint Surg Am. 2008; 90: 1876-1883
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Costa M.L.
        • MacMillan K.
        • Halliday D.
        • Chester R.
        • Shepstone L.
        • Robinson A.H.
        • Donell S.T.
        Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis.
        J Bone Joint Surg Br. 2006; 88: 69-77
        • Keating J.F.
        • Will E.M.
        Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome.
        J Bone Joint Surg Br. 2011; 93: 1071-1078
        • Möller M.
        • Movin T.
        • Granhed H.
        • Lind K.
        • Faxén E.
        • Karlsson J.
        Acute rupture of tendon Achillis: a prospective randomised study of comparison between surgical and non-surgical treatment.
        J Bone Joint Surg Br. 2001; 83: 843-848
        • Nilsson-Helander K.
        • Silbernagel K.G.
        • Thomeé R.
        • Faxén E.
        • Olsson N.
        • Eriksson B.I.
        • Karlsson J.
        Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures.
        Am J Sports Med. 2010; 38: 2186-2193
        • Twaddle B.C.
        • Poon P.
        Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study.
        Am J Sports Med. 2007; 35: 2033-2038
        • Willits K.
        • Amendola A.
        • Bryant D.
        • Mohtadi N.G.
        • Giffin J.R.
        • Fowler P.
        • Kean C.O.
        • Kirkley A.
        Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.
        J Bone Joint Surg Am. 2010; 92: 2767-2775
        • Soroceanu A.
        • Sidhwa F.
        • Aarabi S.
        • Kaufman A.
        • Glazebrook M.
        Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials.
        J Bone Joint Surg Am. 2012; 94: 2136-2143
        • Wallace R.G.
        • Heyes G.J.
        • Michael A.L.R.
        The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of rerupture.
        J Bone Joint Surg Br. 2011; 93: 1362-1366
        • Nilsson-Helander K.
        • Thurin A.
        • Karlsson J.
        • Eriksson B.I.
        High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1234-1238