NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA.
National University Health System, Singapore, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3528-3540. doi: 10.1007/s00167-023-07411-1. Epub 2023 Apr 28.
To systematically review and evaluate the current meta-analyses for the treatment of acute Achilles tendon rupture (AATR). This study can provide clinicians with a clear overview of the current literature to aid clinical decision-making and the optimal formulation of treatment plans for AATR.
Two independent reviewers searched PubMed and Embase on June 2, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of evidence was twofold: level of evidence (LoE) and quality of evidence (QoE). LoE was evaluated using published criteria by The Journal of Bone and Joint Surgery and the QoE by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Pooled complication rates were highlighted for significance in favour of one treatment arm or no significance.
There were 34 meta-analyses that met the eligibility criteria, with 28 studies of LoE 1, and the mean QoE was 9.8 ± 1.2. Significantly lower re-rupture rates were reported with surgical (2.3-5%) versus conservative treatment (3.9-13%), but conservative treatment was favoured in terms of lower complication rates. The re-rupture rates were not significantly different between percutaneous repair or minimally invasive surgery (MIS) compared to open repair, but MIS was favoured in terms of lower complication rates (7.5-10.4%). When comparing rehabilitation protocols following open repair (four studies), conservative treatment (nine studies), or combined (three studies), there was no significant difference in terms of re-rupture or obvious advantage in terms of lower complication rates between early versus later rehabilitation.
This systematic review found that surgical treatment was significantly favoured over conservative treatment for re-rupture, but conservative treatment had lower complication rates other than re-rupture, notably for infections and sural nerve injury. Open repair had similar re-rupture rates to MIS, but lower complication rates; however, the rate of sural nerve injuries was lower in open repair. When comparing earlier versus later rehabilitation, there was no difference in re-rupture rates or obvious advantage in complications between open repair, conservative treatment, or when combined. The findings of this study will allow clinicians to effectively counsel their patients on the postoperative outcomes and complications associated with different treatment approaches for AATR.
IV.
系统回顾和评估急性跟腱断裂（AATR）治疗的现有荟萃分析。本研究可为临床医生提供当前文献的清晰概述，以辅助临床决策和制定 AATR 的最佳治疗计划。
根据《系统评价和荟萃分析的首选报告项目》（PRISMA）指南，两名独立评审员于 2022 年 6 月 2 日在 PubMed 和 Embase 上进行了搜索。证据评估有两个方面：证据水平（LoE）和证据质量（QoE）。使用《骨与关节外科杂志》发表的标准评估 LoE，使用系统评价方法学质量评估（AMSTAR）量表评估 QoE。强调汇总并发症发生率以表明对一种治疗方法有利或无显著差异。
有 34 项荟萃分析符合入选标准，其中 28 项研究的 LoE 为 1 级，平均 QoE 为 9.8±1.2。与保守治疗（3.9-13%）相比，手术治疗（2.3-5%）的再断裂率显著降低，但保守治疗的并发症发生率较低。经皮修复或微创外科（MIS）与开放修复相比，再断裂率无显著差异，但 MIS 的并发症发生率较低（7.5-10.4%）。在比较开放修复（4 项研究）、保守治疗（9 项研究）或联合治疗（3 项研究）后的康复方案时，在再断裂方面，早期与晚期康复之间没有显著差异，在降低并发症发生率方面也没有明显优势。
本系统评价发现，与保守治疗相比，手术治疗在再断裂方面明显更受青睐，但保守治疗的再断裂以外的并发症发生率较低，尤其是感染和腓肠神经损伤。与 MIS 相比，开放修复的再断裂率相似，但并发症发生率较低；然而，开放修复的腓肠神经损伤发生率较低。在比较早期与晚期康复时，在再断裂率方面，开放修复、保守治疗或联合治疗之间没有差异，并发症方面也没有明显优势。本研究的结果将使临床医生能够有效地向患者提供不同治疗方法与 AATR 相关的术后结果和并发症的信息。
IV。
