Fan Lei, Hu Yunan, Zhou Leng, Fu Weili
Sports Medicine Center, Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Cheng Du, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Cheng Du, China.
Front Surg. 2024 Nov 21;11:1483584. doi: 10.3389/fsurg.2024.1483584. eCollection 2024.
Acute Achilles tendon rupture (AATR) is common among young individuals. There are various management options available, including conservative treatment, open surgical repair, and minimally invasive treatments. However, the optimal treatment approach remains controversial.
In this study, we conducted a thorough analysis of the existing literature to compare the clinical outcomes of surgical and nonoperative treatments for patients with AATR by conducting a meta-analysis of randomized controlled trials.
Meta analysis; Level of evidence, 1.
Eligible trials randomly assigned adults with AATR to surgical or conservative treatment and assessed by three independent reviewers. We searched in PubMed, Embase, and The Cochrane Library. The assessment of risk of bias was conducted by entering the data from each included study into the Revman computer program. Extracted data were meta-analyzed. Heterogeneity was evaluated using the I2 test. Pooled results were expressed as odds ratios, risk ratios (OR), and mean differences (MD).
The meta-analysis included a total of 14 studies and 1,399 patients, with 696 patients receiving surgical intervention and 703 patients undergoing non-surgical treatment. The follow- up duration ranged from 12 to 30 months. The surgical group was found to have a significantly lower re-rupture rate (OR: 0.30, 95% CI: 0.18-0.54; < 0.00001), but also had a higher risk of other complications (OR: 3.28, 95% CI: 1.56-6.93, = 0.002). The surgical group also had significantly abnormal calf (OR: 0.45, 95% CI: 0.26-0.76, = 0.03). There was no statistically significant difference between the two groups in terms of returning to sports, ATRS, abnormal motion of foot and ankle, unable heel-rise, and torque for plantar flexion.
The meta-analysis results indicate that surgical intervention for AATR is associated with a lower re-rupture rate, but a higher risk of other complications. Our assessment of life-quality and functional outcomes also suggests that surgery leads to significantly better outcomes in terms of sick leave, abnormal calf, and torque for plantar flexion. Based on these findings, we recommend that surgery is a preferable option for patients who have a higher risk of re-rupture and require a quick rehabilitation.
急性跟腱断裂（AATR）在年轻人中很常见。有多种治疗选择，包括保守治疗、开放手术修复和微创治疗。然而，最佳治疗方法仍存在争议。
在本研究中，我们通过对随机对照试验进行荟萃分析，对现有文献进行了全面分析，以比较AATR患者手术和非手术治疗的临床结果。
荟萃分析；证据级别，1级。
符合条件的试验将成年AATR患者随机分配至手术或保守治疗组，并由三名独立评审员进行评估。我们在PubMed、Embase和Cochrane图书馆进行了检索。通过将每项纳入研究的数据输入Revman计算机程序进行偏倚风险评估。对提取的数据进行荟萃分析。使用I²检验评估异质性。汇总结果以比值比、风险比（OR）和平均差（MD）表示。
荟萃分析共纳入14项研究和1399例患者，其中696例接受手术干预，703例接受非手术治疗。随访时间为12至30个月。发现手术组再断裂率显著较低（OR：0.30，95%CI：0.18 - 0.54；P < 0.00001），但其他并发症风险较高（OR：3.28，95%CI：1.56 - 6.93，P = 0.002）。手术组小腿也明显异常（OR：0.45，95%CI：0.26 - 0.76，P = 0.03）。两组在恢复运动、ATRS、足踝异常活动、无法足跟抬起和跖屈扭矩方面无统计学显著差异。
荟萃分析结果表明，AATR的手术干预与较低的再断裂率相关，但其他并发症风险较高。我们对生活质量和功能结果的评估还表明，手术在病假、小腿异常和跖屈扭矩方面导致明显更好的结果。基于这些发现，我们建议对于再断裂风险较高且需要快速康复的患者，手术是更可取的选择。
