Rupture of the Achilles tendon is common and said to be increasing. It typically occurs in males in their 30s and 40s who play sport intermittently. People present with severe pain in the tendon, at the back of the ankle. Signs include a palpable gap at the rupture site, and marked weakness of ankle plantar-flexion (movement so toes point downwards). Options for management include non-surgical interventions (plaster of Paris, bracing or splinting) or surgical repair of the tendon. Following either method of treatment, the ankle may be immobilised for up to 12 weeks (in a cast, allowing no movement at the ankle and variable weight-bearing), or mobilised early (in a brace, allowing movement at the ankle and partial to full weight-bearing).
Twelve trials including 794 participants acute Achilles tendon rupture were included. The majority of participants were male, and the average ages of the study populations were between 36 to 41 years. Many of the trials had flawed methods that undermined the reliability of their results.
Open surgical treatment compared with non-surgical treatment (6 studies, 502 participants) was associated with a lower risk of rerupture, but a higher risk of other complications such as infection, adhesions and disturbed skin sensibility (numbness and tingling). There were insufficient and inconclusive data on function and sporting activities.
Percutaneous repair (involving stab incisions through which the repair suture is passed through without direct exposure of the tendon) compared with open repair (4 studies, 174 participants) was associated with a lower risk of infection. These figures should be interpreted with caution because of the small numbers involved. Similarly, no definitive conclusions could be made regarding different tendon repair techniques (3 studies, 141 participants).