title: Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?: A Systematic Review of Overlapping Meta-analyses.
abstract: BACKGROUND
  Multiple meta-analyses have been published in efforts to determine whether operative or nonoperative treatment of Achilles tendon ruptures affords superior outcomes.
  
  
  OBJECTIVE
  To perform a systematic review of overlapping meta-analyses comparing operative and nonoperative treatment of Achilles tendon ruptures to determine which meta-analyses provide the highest level of evidence for treatment recommendations.
  
  
  METHODS
  Systematic review; Level of evidence, 3.
  
  
  METHODS
  A systematic review of the literature was performed to identify meta-analyses that fit the study inclusion criteria. Data were extracted from these meta-analyses regarding patient outcomes and reruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and QUOROM (Quality of Reporting of Meta-analyses) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence.
  
  
  RESULTS
  Nine meta-analyses met the eligibility criteria, with all but 1 study including level 1 evidence. A total of 5842 patients were included. Seven studies found a higher rate of rerupture in the nonoperative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and 1 study found surgery decreased rerupture rates only when compared with nonoperative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 of 9) of the meta-analyses had Oxman-Guyatt scores >3, indicating no major flaws.
  
  
  CONCLUSIONS
  Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared with nonoperative treatment. Additionally, surgical treatment may allow earlier return to work.
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: Randy
authors.initials: R
authors.lastname: Mascarenhas
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Saltzman
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: David
authors.initials: D
authors.lastname: Walton
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
keywords: Achilles tendon; complication; nonoperative meta-analysis; rupture