Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

Feng, Shi-Ming; Maffulli, Nicola; Oliva, Francesco; Saxena, Amol; Hao, Yue-Feng; Hua, Ying-Hui; Xu, Hai-Lin; Tao, Xu; Xu, Wei; Migliorini, Filippo; Ma, Chao

Abstract

Background
Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes.

Methods
A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines.

Results
Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol.

Conclusion
Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.

Citation

Feng, S., Maffulli, N., Oliva, F., Saxena, A., Hao, Y., Hua, Y., …Ma, C. (in press). Surgical management of chronic Achilles tendon rupture: evidence-based guidelines. Journal of Orthopaedic Surgery and Research, 19(1), Article 132. https://doi.org/10.1186/s13018-024-04559-5

• Journal Article Type: Article
• Acceptance Date: Jan 11, 2024
• Online Publication Date: Feb 10, 2024
• Deposit Date: Feb 19, 2024
• Journal: Journal of Orthopaedic Surgery and Research
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 1
• Article Number: 132
• DOI: https://doi.org/10.1186/s13018-024-04559-5
• Keywords: Surgical management, Guidelines, Chronic Achilles tendon rupture
• Publisher URL: https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-04559-5