España Fernández de Valderrama Sara, García Martínez Beatriz, Ezquerra Herrando Laura
Orthopaedic Surgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Foot Ankle Orthop. 2025 Apr 29;10(2):24730114251327219. doi: 10.1177/24730114251327219. eCollection 2025 Apr.
Acute Achilles tendon rupture (ATR) has increased in recent decades, reflecting the longer life expectancy and higher levels of activity. Surgical intervention has been the main treatment, but recently there has been growing interest in nonoperative approaches. Study compares surgical and conservative treatment of acute ATR, examining demographic data, rerupture rate, complications, and functional scale Achilles Total Tendon Rupture Score (ATRS).
A literature review was conducted including randomized clinical trials and prospective cohorts. RevMan software was employed to ascertain the ² heterogeneity, with a view to determining whether a fixed or random effects model should be used for meta-analysis. The results were expressed as either the mean difference or relative risk (RR), as appropriate, with 95% CI.
Ten studies, published after 2010, were included in the analysis. Of the total 1327 participants, 57.8% received surgical treatment and 42.2% nonsurgical treatment. The follow-up was between 12-24 months. The rerupture rate was lower in surgical treatment (RR 0.28, 95% CI 0.15-0.50; < .0001), although this was accompanied by a higher risk of complications (RR 2.39, 95% CI 1.57-3.63; < .0001). The patient satisfaction was comparable between the 2 treatment groups, with no statistically significant difference on the ATRS scale (MD 0.87, 95% CI -1.18 to 2.92; = .40).
Surgical repair of acute ATR significantly reduces the risk of rerupture but it is associated with a higher rate of complications. Furthermore, there are no significant differences in the various functional scales in terms of patient satisfaction between the 2 treatments.
II, meta-analysis.
近几十年来，急性跟腱断裂（ATR）的发病率有所上升，这反映了预期寿命的延长和活动水平的提高。手术干预一直是主要的治疗方法，但最近人们对非手术方法的兴趣日益浓厚。本研究比较急性ATR的手术治疗和保守治疗，研究人口统计学数据、再断裂率、并发症以及功能评分跟腱总断裂评分（ATRS）。
进行文献综述，纳入随机临床试验和前瞻性队列研究。使用RevMan软件确定异质性，以决定应使用固定效应模型还是随机效应模型进行荟萃分析。结果以均值差或相对风险（RR）表示，并给出95%置信区间（CI）。
分析纳入了2010年后发表的10项研究。在总共1327名参与者中，57.8%接受了手术治疗，42.2%接受了非手术治疗。随访时间为12至24个月。手术治疗的再断裂率较低（RR 0.28，95% CI 0.15 - 0.50；P < 0.0001），尽管这伴随着更高的并发症风险（RR 2.39，95% CI 1.57 - 3.63；P < 0.0001）。两个治疗组的患者满意度相当，在ATRS量表上无统计学显著差异（MD 0.87，95% CI -1.18至2.92；P = 0.40）。
急性ATR的手术修复显著降低了再断裂的风险，但并发症发生率较高。此外，两种治疗方法在患者满意度的各项功能量表方面没有显著差异。
II级，荟萃分析。
