Complications In The Treatment Of Acute Achilles Tendon Rupture

Background: Acute Achilles tendon rupture(ATR)has increased in the last decade and many new treatments and rehabilitation regimens have been introduced.But the major complications in ATR managements remain an unsolved problem.The objective of this systematic review and network meta-analysis was to compare the risk of major complications of acute ATR after different combinations of treatments and rehabilitation regimens.Method: We searched four databases,including PubMed,Medline,Embase,and the Cochrane library,from their date of inception until Feb 2018 for articles in English.We considered randomized controlled trials(RCTs)comparing interventions and rehabilitation protocols for acute ATR.We restricted interventions to conservative treatment,minimally invasive surgery,and open surgery,and rehabilitation protocols to accelerated rehabilitation and early immobilization.Major complications were assessed,including re-rupture,deep infection,and deep vein thrombosis.We only considered patients with primary acute ATR.Quality assessment was performed using the Cochrane risk of bias tool.A series of additional tests have been conducted to ensure the validity of the results.Results: 29 RCTs with a total number of 2060 patients were included in this Bayesian network meta-analysis(NMA).We discovered that the average incidence of overall major complications from all managements is 9.13% with 6.67% median.The average incidence of re-rupture,deep infection and DVT from all managements are 5%,1.50% and 2.67% respectively.According to relative risk,Conservative treatment combined with early immobilization was significantly associated with a higher risk of major complications.According to the surface under the cumulative ranking curve(SUCRA),minimally invasive surgery with accelerated rehabilitation had the highest possibility(79.7%)of being the best management with regard to minimizing major complications.Conclusion: For treating acute ATR,according to SUCRA,management combining minimally invasive surgery with accelerated rehabilitation had the highest possibility to be superior in terms of major complication risks.And Management combining conservative treatment with early immobilization was statistically associated with a higher risk of complications compared with the other methods of management.