87 Surgical Versus Conservative Management of Acute Achilles Tendon Ruptures; A Systematic Review and Meta-Analysis

Abstract

Abstract Aim To compare the functional outcomes including re-rupture rates, number of participants failing to return to work or sports and scoring scales between surgical and conservative treatment in a systematic review. Method A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) protocol. Studies were identified from these databases: PubMed, Cochrane and CINAHL. Risk-ratio analysis to compare rupture rates and failure to return to work/sports, whilst a standard mean difference analysis compared the functional outcome scores from both treatment groups. Results Seven randomised controlled trial studies included with a total of 486 participants involved in the trials, comprising of 245 participants for surgical intervention and 209 participants for conservative management. There is a higher re-rupture rate in the conservative group compared to the surgical group with a risk ratio (RR) of 0.38 (95% CI 0.16–0.92, P = 0.03). Statistically, there was no significant difference in number of individuals failing to return to work/sports in both treatment modalities, RR for all the three studies were 0.85 (95% CI 0.51,1.41, P = 0.52). A standardised mean analysis with an overall effect Z of 0.40 (std MD 0.09; P 0.69; 95%CI -0.35,0.53) indicate no statistically significant difference in the functional outcomes between the three different studies. Conclusions Surgical intervention only shows an advantage over conservative treatment in terms of re-rupture rates but similar results with conservative treatment when other outcomes including number of participants returning to previous activity levels, plantar flexion and functional scoring systems were assessed.