Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review of overlapping meta-analyses.
BACKGROUND
A number of meta-analyses have been carried out to evaluate the effects of minimally invasive surgery (MIS) versus open surgery (OS) for acute Achilles tendon rupture. However, discordant findings were seen in these meta-analyses. The present study, performing a systematic review of overlapping meta-analyses regarding MIS versus OS of acute Achilles tendon rupture, aimed to assist decision-makers interpret and choose among conflicting meta-analyses, as well as to offer treatment recommendations based on current best evidence.


METHODS
The literature search was performed to identify systematic reviews comparing MIS with OS for Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors individually evaluated the quality of meta-analysis and extracted data. The Jadad decision algorithm was conducted to ascertain which meta-analysis offered the best evidence.


RESULTS
A total of four meta-analyses was included. All these meta-analyses comprised RCTs or quasi-RCTs and were determined as Level-II evidence. The scores of the Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 7 to 10 (median 9.5). The Jadad algorithm indicated that the best meta-analysis should be chosen according to the search strategies and application of selection. A high-quality meta-analysis with more RCTs was chosen, which suggested that there was no statistically significant difference between MIS and OS regarding rerupture rate, tissue adhesion, sural nerve injury, deep infection, and deep vein thrombosis. However, MIS could decrease superficial infection rate, and had a better patient satisfaction for good to excellent outcomes in comparison to OS.


CONCLUSIONS
Based on the best available evidence, MIS may be superior to OS for treating acute Achilles tendon rupture. However, due to some limitations, this should be cautiously interpreted, and further high-quality studies are needed.
Department of Orthopaedic Trauma, The Second Hospital of Shandong University, Jinan, People's Republic of China.
Qingbo
Q
Li
Department of Rehabilitation, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No.1 Jingba Road, Jinan, 250001, People's Republic of China. wangchuanyingjinan@163.com.
Chuanying
C
Wang
Department of Orthopaedic Trauma, The Second Hospital of Shandong University, Jinan, People's Republic of China.
Yanqing
Y
Huo
Department of Orthopaedics, The 306th Hospital of People's Liberation Army, Beijing, People's Republic of China. jiazhiwei@139.com.
Zhiwei
Z
Jia
Department of Orthopaedic Trauma, The Second Hospital of Shandong University, Jinan, People's Republic of China.
Xiqian
X
Wang
D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000465:Algorithms; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012421:Rupture / Q000601:surgery
Achilles tendon rupture; Meta-analysis; Minimally invasive surgery; Open surgery; Systematic review