When it comes to treating Achilles Tendon re-ruptures, surgery is more effective than nonsurgical management, according to a new study.
Surgery Best for Treating Achilles Tendon Re-ruptures
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Secondary#achillestendonrupture#minimallyinvasivesurgery#rerupturerates
In the study, “Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best-and-Worst-Case Analyses for Rerupture Rates,” published online on March 30, 2021 in The American Journal of Sports Medicine, the researchers analyzed rates of all complications after the treatment of acute Achilles tendon rupture.
The Achilles tendon, the cord that connects the back of the calf to the heel bone, can tear if it is overstretched. It is most commonly seen in athletes.
The researchers used a “best-case scenario” and “worst-case scenario” analysis for re-rupture rate that assumes that all patients lost to follow-up did not or did experience a re-rupture, respectively.
“An acute Achilles tendon rupture is a common injury. The controversy that has surrounded the optimal treatment options for acute Achilles tendon ruptures warrants an updates meta-analysis that is comprehensive, accounts for loss to follow-up, and utilizes the now greater number of available studies for data pooling,” they wrote.
Overall surgical treatment did better at reducing retear risk, but other complications like infection were actually less in the nonsurgical treatment group. Compared with open repair, minimally invasive surgery was associated with fewer complications. There was no difference, however, in re-rupture rates between the two types of surgeries.
“This meta-analysis demonstrated that surgical treatment was superior to nonsurgical treatment in terms of re-ruptures. However, the number needed to treat analysis produced non meaningful values for all treatment options, except for surgical versus nonsurgical treatment and minimally invasive surgery versus open repair,’ the researchers wrote.
“No single treatment option was revealed to be profoundly favorable with respect to every complication. The results of this meta-analysis can guide clinicians and patients in their treatment decisions that should be made jointly and on a case-by-case basis.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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