Operative vs. Non-Operative Treatment of Achilles Tendon Ruptures: A Systematic Review of Overlapping Meta-analyses

OBJECTIVES: Background: Multiple meta-analyses have been published to in efforts to determine whether operative or non-operative treatment of Achilles tendon ruptures affords superior outcomes. The results, however, remain varied and inconsistent. PURPOSE: To perform a systematic review of overlapping meta-analyses comparing operative and non-operative treatment of Achilles tendon ruptures in order to determine which meta-analyses provide the highest level of evidence for treatment recommendations. METHODS: Methods: A systematic review of the literature was performed to identify meta-analyses that fit our inclusion criteria. Data was extracted from these meta-analyses regarding patient outcomes and re-ruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence. RESULTS: Results: Nine meta-analyses met the eligibility criteria, with all but one study including level I evidence. A total of 5,842 patients were included. Seven studies found a higher rate of rerupture in the non-operative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and one study found surgery decreased rerupture rates only when compared to non-operative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 out of 9) of the meta-analyses had Oxman-Guyatt scores (>3) indicating no major flaws. CONCLUSION: Conclusions: Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared to non-operative treatment. Additionally, surgical treatment may allow earlier return to work.