Clinical Question: Does surgery prevent the rerupture of acutely ruptured Achilles tendons?

Setting: Various (meta-analysis)

Study Design: Systematic review

Synopsis: The authors searched several databases for randomized controlled trials comparing operative and nonoperative approaches to acute Achilles tendon ruptures. Additionally, they searched multiple sources for unpublished data. Four reviewers independently evaluated all trials, and three reviewers independently extracted the data. They resolved any discrepancies by consensus. Additionally, the team assessed the methodologic quality of the studies using the 12-point Detsky index. Twelve studies of unknown duration (800 patients) were included in the review. One study had a quality score of 10, and one study scored 9; the rest had scores of 7 or less. Rerupture occurred in 3.5 percent of surgical patients and in 12.6 percent of patients treated conservatively (number needed to treat = 11; 95% confidence interval [CI], 7 to 29). Complications such as adhesions, altered sensation, keloids, and infection appeared in 34 percent of patients treated surgically and in 2.7 percent of patients treated nonoperatively (number needed to harm = 4; 95% CI, 2 to 5). These complications were less common when the repair was percutaneous rather than open repair.

Bottom Line: In this systematic review of 12 randomized controlled trials, surgery prevented rerupture in patients with acute rupture of the Achilles tendon. Approximately one out of three patients, however, will have complications ranging from cosmetic to serious. The overall methodologic quality of the studies is poor. (Level of Evidence: 1a)