Evidence map›Paper›PMID 30617123›Full record

SynthesisBMJ (Clinical research ed.)2019

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis.

Yassine Ochen, Reinier B Beks, Mark van Heijl, Falco Hietbrink, Luke P H Leenen, Detlef van der Velde, Marilyn Heng, Olivier van der Meijden, Rolf H H Groenwold, R Marijn Houwert

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 160 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
160citing papers in PubMed, 16 pooled it
33.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

160 citing papers in PubMed, 16 syntheses or guidelines pooled it, 331 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Effects of reduction technique for acute anterior shoulder dislocation without sedation or intra-articular pain management: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023
    Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022
    Pooled it
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Pooled it
  17. Trial
  18. Trial
  19. Trial
  20. Soleus subtendon elongation is reduced by individual suturing of Achilles subtendons after rupture.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026
    Article

100 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 2 countries.

Yassine OchenDepartment of Surgery, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands yassineochen@gmail.com.ORCID http://orcid.org/0000-0002-7187-2055
Reinier B BeksDepartment of Surgery, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands.
Mark van HeijlDepartment of Surgery, Diakonessenhuis Hospital, Utrecht, Netherlands.
Falco HietbrinkDepartment of Surgery, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands.
Luke P H LeenenDepartment of Surgery, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands.
Detlef van der VeldeDepartment of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands.
Marilyn HengDepartment of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA, USA.
Olivier van der MeijdenDepartment of Orthopedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands.
Rolf H H GroenwoldDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.
R Marijn HouwertDepartment of Surgery, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands.
University Medical Center Utrecht · NLHarvard University · USAmsterdam UMC Location University of Amsterdam · NLLeiden University Medical Center · NLSpaarne Ziekenhuis · NLSt. Antonius Ziekenhuis · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture rate after early and late full weight bearing; to evaluate re-rupture rate after functional rehabilitation with early range of motion; and to compare effect estimates from randomised controlled trials and observational studies.

designSystematic review and meta-analysis. DATA SOURCES: PubMed/Medline, Embase, CENTRAL, and CINAHL databases were last searched on 25 April 2018 for studies comparing operative versus nonoperative treatment of Achilles tendon ruptures. STUDY SELECTION CRITERIA: Randomised controlled trials and observational studies reporting on comparison of operative versus nonoperative treatment of acute Achilles tendon ruptures. DATA EXTRACTION: Data extraction was performed independently in pairs, by four reviewers, with the use of a predefined data extraction file. Outcomes were pooled using random effects models and presented as risk difference, risk ratio, or mean difference, with 95% confidence interval.

results29 studies were included-10 randomised controlled trials and 19 observational studies. The 10 trials included 944 (6%) patients, and the 19 observational studies included 14 918 (94%) patients. A significant reduction in re-ruptures was seen after operative treatment (2.3%) compared with nonoperative treatment (3.9%) (risk difference 1.6%; risk ratio 0.43, 95% confidence interval 0.31 to 0.60; P<0.001; I

conclusionsThis meta-analysis shows that operative treatment of Achilles tendon ruptures reduces the risk of re-rupture compared with nonoperative treatment. However, re-rupture rates are low and differences between treatment groups are small (risk difference 1.6%). Operative treatment results in a higher risk of other complications (risk difference 3.3%). The final decision on the management of acute Achilles tendon ruptures should be based on patient specific factors and shared decision making. This review emphasises the potential benefits of adding high quality observational studies in meta-analyses for the evaluation of objective outcome measures after surgical treatment.

Indexed as

Outcome Assessment, Health CareAchilles TendonFemaleHumansMaleObservational Studies as TopicRandomized Controlled Trials as TopicRecurrenceRisk FactorsRupture

Identifiers

PMID30617123
PMCPMC6322065
OpenAlexW2907087401

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.