SLR - August 2016 - Olga Shvets

Minimally Invasive Versus Open Surgery for Acute Achilles Tendon Rupture: A Systematic Review of Overlapping Meta-Analysis

Reference: Li Q, Wang C, Huo Y, Jia Z, Wang X. Minimally Invasive Versus Open Surgery for Acute Achilles Tendon Rupture: A Systematic Review of Overlapping Meta-Analysis. Journal of Orthopaedic Surgery and Research. 2016;11:65. doi:10.1186/s13018-016-0401-2.

Scientific Literature Review

Reviewed By: Olga Shvets, DPM
Residency Program: SUNY Downstate Medical Center

Podiatric Relevance: Acute Achilles tendon ruptures are frequent traumatic injuries that are treated surgically or nonsurgically by podiatric surgeons and would benefit from a consistent protocol. A number of surgeons choose surgical repair, as there is a high risk of rerupture with nonsurgical repair. Li et al provide treatment recommendations based on current best evidence. Studies have compared minimally invasive surgery (MIS) and open surgery (OS), but the findings are conflicting. This study reviewed overlapping meta-analyses regarding minimally invasive versus invasive treatment of acute Achilles tendon ruptures.  

Methods: Investigators systematically reviewed PubMed, Embase and Cochrane Library in 2015 with keywords Achilles, systematic review and meta-analysis. The references of the included studies were also checked to find possible meta-analyses. All meta-analyses were determined as Level II evidence, and high-quality meta-analysis with more RCTs were selected as the current best available evidence. The inclusion criteria were: comparing MIS with OS for acute Achilles tendon rupture, a meta-analysis only comprising RCTs and at least one outcome (such as rerupture rate and functional outcome). The Jadad decision algorithm was used to investigate the origin of inconsistency among systematic reviews.

Results: This systematic review included 16 studies that demonstrated that MIS for Achilles tendon rupture provided a lower superficial infection rate and a better subjective patient satisfaction rate, while not raising the risk of rerupture, tissue adhesion, Sural nerve injury, deep infection and deep vein thrombosis in comparison to OS. Based on the best available evidence, MIS may be superior to OS for treating acute Achilles tendon rupture.

Conclusions: The best available evidence suggests that MIS may be superior to OS for the treatment of acute Achilles tendon rupture. Results should be interpreted with caution as the review includes only a sample size of sixteen. Another limitation to the study is only meta-analyses of RCTs were compared, due to the evidence available. Lastly, the search criteria did not include very many variables in the keyword search. Adding more variety in the search may have produced a larger sample size. Overall, the study attempted to establish a treatment protocol for acute Achilles tendon ruptures. Based on the results, practitioners are able to be more discerning when deciding between MIS and OS for acute Achilles tendon ruptures. 

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