Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec 23;7(1):247.
doi: 10.1186/s13643-018-0912-5.

Protocol for treatment of Achilles tendon ruptures; a systematic review with network meta-analysis

Brad Meulenkamp  1 , Dawn Stacey  2 , Dean Fergusson  3 , Brian Hutton  4 , Risa Shorr Mlis  5 , Ian D Graham  6
Affiliations

Protocol for treatment of Achilles tendon ruptures; a systematic review with network meta-analysis

Brad Meulenkamp et al. Syst Rev. .

Abstract

Background: Achilles tendon ruptures are a common injury and are increasing in incidence. Several management strategies exist for both non-operative and operative care, with each strategy offering unique risks and benefits. Traditional pairwise meta-analyses have been performed to compare management strategies; however, all treatment options have never been integrated in a single analysis. Network meta-analysis (NMA) is a generalization of pairwise meta-analysis, which allows for the comparison of multiple interventions based on all available direct and indirect evidence. The objectives of this review are to synthesize the evidence on the management options for acute Achilles tendon rupture and identify which treatment gives the best functional outcomes.

Methods: A systematic review with NMA is planned. An electronic literature search will be performed in conjunction with an experienced information specialist in MEDLINE, EMBASE, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials. We will include randomized controlled trials with a minimum 6-month follow-up. Two independent reviewers will screen citations for eligibility, extract study data, and perform risk of bias assessments. The primary outcome will be disease-specific functional outcome scores (AOFAS, Leppilahti, modified Leppilahti) at 1 year. Secondary outcomes will include complications (re-rupture, sural nerve injury, wound complications, deep infection, secondary surgeries), strength, range of motion, return to work, return to sport, and quality-of-life measures (including the SF-36 questionnaire). Traditional pairwise meta-analyses will be performed for all direct comparisons where evidence is available, and NMAs will subsequently be performed where possible to compare all management strategies.

Discussion: The data generated from this review will provide health-care providers with a clear evidence synthesis of all Achilles tendon rupture management strategies. Additionally, these data will be incorporated into the development of a patient decision aid to assist patients and clinicians in making a preference-based decision when faced with an Achilles tendon rupture.

Systematic review registration: PROSPERO CRD42018093033 .

Keywords: Achilles tendon rupture; Network meta-analysis; Orthopedics; Physiotherapy; Surgery; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Mattila VM, Huttunen TT, Haapasalo H, Sillanpää P, Malmivaara A, Pihlajamäki H. Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med. 2015;49:1084–1086. doi: 10.1136/bjsports-2013-092756. - DOI - PubMed
    1. Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, et al. Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:503–510. doi: 10.5435/00124635-201008000-00007. - DOI - PubMed
    1. Huttunen TT, Kannus P, Rolf C, Felländer-Tsai L, Mattila VM. Acute Achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med. 2014;42:2419–2423. doi: 10.1177/0363546514540599. - DOI - PubMed
    1. Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal SB. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Joint J. 2017;99-B:78–86. doi: 10.1302/0301-620X.99B1.BJJ-2016-0434.R1. - DOI - PubMed
    1. Kou J. AAOS clinical practice guideline: acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:511–513. doi: 10.5435/00124635-201008000-00008. - DOI - PubMed

Publication types