The Journal of Bone and Joint Surgery (American). 2005;87:2202-2210.
doi:10.2106/JBJS.D.03049
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Letters to the Editor: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Related articles in JBJS
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Khan, R. J.K.
Right arrow Articles by Parker, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Khan, R. J.K.
Right arrow Articles by Parker, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Treatment of Acute Achilles Tendon Ruptures

A Meta-Analysis of Randomized, Controlled Trials

Riaz J.K. Khan, FRCS(Tr&Orth)1, Dan Fick, MBBS2, Angus Keogh, MBBS2, John Crawford, FRCS(Tr&Orth)3, Tim Brammar, FRCS(Tr&Orth)3 and Martyn Parker, MD4

1 Department of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, United Kingdom. E-mail address: riazkhan{at}aol.com
2 Department of Surgery and Pathology, University of Western Australia, Perth, WA 6009, Australia
3 Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom
4 Peterborough District Hospital, Peterborough, PE3 6DA, United Kingdom

Investigation performed at Perth Orthopaedic Institute, Department of Surgery and Pathology, University of Western Australia, Perth, Australia

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: There is a lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture. Treatment can be broadly classified as operative (open or percutaneous) or nonoperative (casting or functional bracing). Postoperative splinting can be performed with a rigid cast (proximal or distal to the knee) or a more mobile functional brace. The aim of this meta-analysis was to identify and summarize the evidence from randomized, controlled trials on the effectiveness of different interventions for the treatment of acute Achilles tendon ruptures.

Methods: We searched multiple databases (including EMBASE, CINAHL, and MEDLINE) as well as reference lists of articles and contacted authors. Keywords included Achilles tendon, rupture, and tendon injuries. Three reviewers extracted data and independently assessed trial quality with use of a ten-item scale.

Results: Twelve trials involving 800 patients were included. There was a variable level of methodological rigor and reporting of outcomes. Open operative treatment was associated with a lower risk of rerupture compared with nonoperative treatment (relative risk, 0.27; 95% confidence interval, 0.11 to 0.64). However, it was associated with a higher risk of other complications, including infection, adhesions, and disturbed skin sensibility (relative risk, 10.60; 95% confidence interval, 4.82 to 23.28). Percutaneous repair was associated with a lower complication rate compared with open operative repair (relative risk, 2.84; 95% confidence interval, 1.06 to 7.62). Patients who had been managed with a functional brace postoperatively (allowing for early mobilization) had a lower complication rate compared with those who had been managed with a cast (relative risk, 1.88; 95% confidence interval, 1.27 to 2.76). Because of the small number of patients involved, no definitive conclusions could be made regarding different nonoperative treatment regimens.

Conclusions: Open operative treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared with nonoperative treatment, but operative treatment is associated with a significantly higher risk of other complications. Operative risks may be reduced by performing surgery percutaneously. Postoperative splinting with use of a functional brace reduces the overall complication rate.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?

Related articles in JBJS:

Treatment of Acute Achilles Tendon Ruptures
Riaz J.K. Khan
JBJS 2006 88: 1160. [Extract] [Full Text]  

Treatment of Acute Achilles Tendon Ruptures. A Meta-Analysis of Randomized, Controlled Trials
Michael H. Dobson and Chinh Nguyen
JBJS 2006 88: 1160. [Extract] [Full Text]  



This article has been cited by other articles:


Home page
 Foot Ankle SpecHome page
W. H. Wray III, C. Regan, S. Patel, R. May, and S. G. Parekh
Positional Effects of the Knee and Ankle on the Ends of Acute Achilles Tendon Ruptures
Foot & Ankle Specialist, October 1, 2009; 2(5): 214 - 218.
[Abstract] [PDF]

Home page
 JBJSHome page
A. Pajala, J. Kangas, P. Siira, P. Ohtonen, and J. Leppilahti
Augmented Compared with Nonaugmented Surgical Repair of a Fresh Total Achilles Tendon Rupture. A Prospective Randomized Study
J. Bone Joint Surg. Am., May 1, 2009; 91(5): 1092 - 1100.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
A. A. Suchak, G. P. Bostick, L. A. Beaupre, D. C. Durand, and N. M. Jomha
The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
J. Bone Joint Surg. Am., September 1, 2008; 90(9): 1876 - 1883.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
B. C. Twaddle and P. Poon
Early Motion for Achilles Tendon Ruptures: Is Surgery Important?: A Randomized, Prospective Study
Am. J. Sports Med., December 1, 2007; 35(12): 2033 - 2038.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
K.-l. Tang, H. Thermann, G. Dai, G.-x. Chen, L. Guo, and L. Yang
Arthroscopically Assisted Percutaneous Repair of Fresh Closed Achilles Tendon Rupture by Kessler's Suture
Am. J. Sports Med., April 1, 2007; 35(4): 589 - 596.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
G. Treme, J. A. Hart, and M. D. Miller
What's New in Sports Medicine
J. Bone Joint Surg. Am., March 1, 2007; 89(3): 686 - 696.
[Full Text] [PDF]

Home page
 Am J Sports MedHome page
K. Nilsson-Helander, R. Thomee, K. Gravare-Silbernagel, P. Thomee, E. Faxen, B. I. Eriksson, and J. Karlsson
The Achilles Tendon Total Rupture Score (ATRS): Development and Validation
Am. J. Sports Med., March 1, 2007; 35(3): 421 - 426.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
R. Kotnis, S. David, R. Handley, K. Willett, and S. Ostlere
Dynamic Ultrasound as a Selection Tool for Reducing Achilles Tendon Reruptures
Am. J. Sports Med., September 1, 2006; 34(9): 1395 - 1400.
[Abstract] [Full Text] [PDF]

Letters to the Editor:

Read all Letters to the Editor

Inclusion of Poorly Randomized Studies into Meta-Analysis
Michael H. Dobson, et al.
JBJS Online, 14 Dec 2005 [Full text]
Non-operative treatment of Achilles Tendon Ruptures
Paul E. Levin
JBJS Online, 13 Dec 2005 [Full text]
Dr. Khan et al respond to Drs. Dobson and Nguyen
Riaz, J.K. Khan, et al.
JBJS Online, 14 Dec 2005 [Full text]
Treatment of Acute Achilles Tendon Ruptures
Riaz J.K. Khan, FRCS (Tr&Orth), et al.
JBJS Online, 15 Feb 2006 [Full text]
Re: Non-operative treatment of Achilles Tendon Ruptures
Angus R. Keogh, MBBS
JBJS Online, 8 Mar 2006 [Full text]