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Review
. 2024 Feb 22:52:112-118.
doi: 10.1016/j.jor.2024.02.034. eCollection 2024 Jun.

Comparison of rerupture rates after operative and nonoperative management of Achilles tendon rupture in older populations: Systematic review and meta-analysis

Daniel Acevedo  1   2 , Jose R Garcia  1 , Rajvarun S Grewal  3 , Ashish Vankara  2 , Christopher J Murdock  2 , Patrick C Hardigan  1 , Amiethab A Aiyer  2
Affiliations
Review

Comparison of rerupture rates after operative and nonoperative management of Achilles tendon rupture in older populations: Systematic review and meta-analysis

Daniel Acevedo et al. J Orthop. .

Erratum in

Abstract

Background: This systematic review and meta-analysis investigated the treatment for Achilles tendon rupture (ATR) associated with the lowest risk of rerupture in older patients.

Methods: Five databases were searched through September 2022 for studies published in the past 10 years analyzing operative and nonoperative ATR treatment. Studies were categorized as "nonelderly" if they reported only on patients aged 18-60 years. Studies that included at least 1 patient older than age 70 were categorized as "elderly inclusive." Of 212 studies identified, 28 were eligible for inclusion. Of 2965 patients, 1165 were treated operatively: 429 (37%) from elderly-inclusive studies and 736 (63%) from nonelderly studies. Of the 1800 nonoperative patients 553 (31%) were from nonelderly studies and 1247 (69%) were from elderly-inclusive studies.

Results: For nonoperative treatment, the rate of rerupture was higher in nonelderly studies (83/1000 cases, 95% CI = 58, 113) than in elderly-inclusive studies (38/1000 cases, 95% CI = 22, 58; P<.001). For operative treatment no difference was found in the rate of rerupture between nonelderly studies (7/1000 cases, 95% CI = 0, 21) and elderly-inclusive studies (12/1000 cases, 95% CI = 0, 35; P<.78). Overall, operative treatment was associated with a rerupture rate of 1.5% (95% CI: 1.0%, 2.8%) (P<.001), which was lower than the 5% rate reported by other studies for nonoperative management (P<.001).

Conclusion: Older patients may benefit more than younger patients from nonoperative treatment of ATR. More studies are needed to determine the age at which rerupture rates decrease among nonoperatively treated patients.

Level of evidence: 3.

Keywords: Achilles tendon rupture; Elderly; Geriatric; Nonelderly; Nonoperative treatment; Operative repair; Rerupture rate.

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Conflict of interest statement

D Acevedo reports grants from the 10.13039/501100000026National Institute of Aging Medical Student Training in Aging Research Summer Program during the conduct of the study. AA Aiyer reports personal fees from Vilex and Smith & Nephew, outside the submitted work; is a board or committee member of the American Orthopaedic Foot and Ankle Society; receives publishing royalties, financial or material support from DeLee & Drez's Orthopaedic Sports Medicine (Elsevier) and Miller's Review of Orthopaedics (Elsevier); and is on the editorial or governing board of the Journal of Bone and Joint Surgery-British. The remaining authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Forest plot showing the prevalence of Achilles tendon reruptures (number of reruptures per 1000 cases) after operative or nonoperative treatment.
Fig. 2
Fig. 2
Forest plot showing the prevalence of Achilles tendon reruptures (number of reruptures per 1000 cases) after operative treatment among elderly-inclusive studies (which included patients older than 70 years) and nonelderly studies (which included only patients aged 18–60 years).
Fig. 3
Fig. 3
Forest plot showing the prevalence of Achilles tendon reruptures (number of reruptures per 1000 cases) after nonoperative treatment among elderly-inclusive studies (which included patients older than 70 years) and nonelderly studies (which included only patients aged 18–60 years).
Fig. 4
Fig. 4
Forest plot showing the prevalence of Achilles tendon reruptures (number of reruptures per 1000 cases) after operative or nonoperative treatment for elderly-inclusive studies (which included patients older than 70 years) and nonelderly studies (which included only patients aged 18–60 years).
See this image and copyright information in PMC

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References

    1. Pedowitz D., Kirwan G. Achilles tendon ruptures. Curr Rev Musculoskelet Med. 2013;6(4):285–293. doi: 10.1007/s12178-013-9185-8. - DOI - PMC - PubMed
    1. Raikin S.M., Garras D.N., Krapchev P.V. Achilles tendon injuries in a United States population. Foot Ankle Int. 2013;34(4):475–480. doi: 10.1177/1071100713477621. - DOI - PubMed
    1. Soroceanu A., Sidhwa F., Aarabi S., Kaufman A., Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94(23):2136–2143. doi: 10.2106/JBJS.K.00917. - DOI - PMC - PubMed
    1. Ochen Y., Beks R.B., van Heijl M., et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364 doi: 10.1136/bmj.k5120. - DOI - PMC - PubMed
    1. Holm C., Kjaer M., Eliasson P. Achilles tendon rupture--treatment and complications: a systematic review. Scand J Med Sci Sports. 2015;25(1):e1–e10. doi: 10.1111/sms.12209. - DOI - PubMed

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