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Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery.

Publication ,  Journal Article
Grassi, A; Amendola, A; Samuelsson, K; Svantesson, E; Romagnoli, M; Bondi, A; Mosca, M; Zaffagnini, S
Published in: J Bone Joint Surg Am
November 21, 2018

BACKGROUND: There is no consensus on the optimal technique for repairing an acute Achilles tendon rupture. The purpose of this meta-analysis was to compare the complications, subjective outcomes, and functional results between minimally invasive surgery and open repair of an Achilles tendon rupture. METHODS: A systematic literature search of MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, and ClinicalTrials.gov was performed. Eligible studies were randomized controlled trials (RCTs) comparing minimally invasive surgery and open repair of acute Achilles tendon ruptures. A meta-analysis was performed, while bias and the quality of the evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: Eight studies, with 182 patients treated with minimally invasive surgery and 176 treated with open repair, were included. The meta-analysis showed a significantly decreased risk ratio (RR) of 0.21 (95% confidence interval [CI] = 0.10 to 0.40, p = 0.00001) for overall complications and 0.15 (95% CI = 0.05 to 0.46, p = 0.0009) for wound infection after minimally invasive surgery. Patients treated with minimally invasive surgery were more likely to report good or excellent subjective results (RR = 1.18, 95% CI = 1.04 to 1.33, p = 0.009). No differences between groups were found with respect to reruptures, sural nerve injury, return to preinjury activity level, time to return to work, or ankle range of motion. The overall quality of evidence was generally low because of a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. CONCLUSIONS: There was a significantly decreased risk of postoperative complications, especially wound infection, when acute Achilles tendon rupture was treated with minimally invasive surgery compared with open surgery. Patients treated with minimally invasive surgery were significantly more likely to report a good or excellent subjective outcome. Current evidence is associated with high heterogeneity and a considerable risk of bias. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

November 21, 2018

Volume

100

Issue

22

Start / End Page

1969 / 1981

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Rupture
  • Randomized Controlled Trials as Topic
  • Postoperative Complications
  • Orthopedics
  • Orthopedic Procedures
  • Minimally Invasive Surgical Procedures
  • Humans
  • Achilles Tendon
  • 3202 Clinical sciences
 

Citation

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Grassi, A., Amendola, A., Samuelsson, K., Svantesson, E., Romagnoli, M., Bondi, A., … Zaffagnini, S. (2018). Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery. J Bone Joint Surg Am, 100(22), 1969–1981. https://doi.org/10.2106/JBJS.17.01364
Grassi, Alberto, Annunziato Amendola, Kristian Samuelsson, Eleonor Svantesson, Matteo Romagnoli, Alice Bondi, Massimiliano Mosca, and Stefano Zaffagnini. “Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery.J Bone Joint Surg Am 100, no. 22 (November 21, 2018): 1969–81. https://doi.org/10.2106/JBJS.17.01364.
Grassi A, Amendola A, Samuelsson K, Svantesson E, Romagnoli M, Bondi A, et al. Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery. J Bone Joint Surg Am. 2018 Nov 21;100(22):1969–81.
Grassi, Alberto, et al. “Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery.J Bone Joint Surg Am, vol. 100, no. 22, Nov. 2018, pp. 1969–81. Pubmed, doi:10.2106/JBJS.17.01364.
Grassi A, Amendola A, Samuelsson K, Svantesson E, Romagnoli M, Bondi A, Mosca M, Zaffagnini S. Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery. J Bone Joint Surg Am. 2018 Nov 21;100(22):1969–1981.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

November 21, 2018

Volume

100

Issue

22

Start / End Page

1969 / 1981

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Rupture
  • Randomized Controlled Trials as Topic
  • Postoperative Complications
  • Orthopedics
  • Orthopedic Procedures
  • Minimally Invasive Surgical Procedures
  • Humans
  • Achilles Tendon
  • 3202 Clinical sciences