title: Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses.
abstract: OBJECTIVE
  There is discordance in the results from meta-analyses on surgical versus non-surgical treatment for acute Achilles tendon rupture. We systematically reviewed the overlapping meta-analyses on this topic to provide information that will be helpful to decision makers when selecting treatments based on the current best available evidence.
  
  
  METHODS
  We comprehensively searched multiple databases for systematic reviews that compared surgical and non-surgical treatments for acute Achilles tendon rupture. We only included meta-analyses that comprised randomized controlled trials (RCTs). The methodological quality and extracted data were assessed. The meta-analysis that offered the best evidence was ascertained with the Jadad decision algorithm.
  
  
  RESULTS
  Nine meta-analyses were included in our study and all of them included RCTs with Level-II evidence. Assessment of Multiple Systematic Reviews (AMSTAR) scores ranged from 5 to 10 (median 7). The Jadad decision algorithm was used to select a high-quality meta-analysis with more RCTs. The results from this study showed that when functional rehabilitation was used, non-surgical intervention was similar to surgical treatment regarding the incidence of range of motion, rerupture, calf circumference and functional outcomes, and the incidence of other complications was reduced. Non-surgical intervention significantly increased the rerupture rate if functional rehabilitation was not considered.
  
  
  CONCLUSIONS
  The findings of meta-analyses regarding surgical versus non-surgical treatment for acute Achilles tendon rupture are inconsistent. According to this systematic review of overlapping meta-analyses, the current best available evidence suggests that centers offering functional rehabilitation may prefer non-surgical intervention. Surgical treatment may be preferred at centers that do not have functional rehabilitation.
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Yaohong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Linghan
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Yachao
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Longgang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, The 306th Hospital of People's Liberation Army, No. 9, Anxiangbeili, Beijing, China. Electronic address: jiazhiwei@139.com.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Jia
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Deli
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, China. Electronic address: ruandikengh@163.com.
authors.forename: Dike
authors.initials: D
authors.lastname: Ruan
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000208:Acute Disease; D000465:Algorithms; D003657:Decision Making; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*
keywords: Achilles tendon rupture; Meta-analysis; Non-surgical; Surgical