Systematic review and meta-analysis on the clinical outcome of early vs delayed Tendoachilles repair following Tendoachilles injury

Abstract

Background: Surgical repair is a common treatment for Achilles tendon rupture. The interval before repair may influence outcome, but the evidence is inconsistent, largely from small observational cohorts with differing definitions of delay. Objective: To compare the clinical outcomes of early (≤14 days) and delayed (>14 days) surgical repair after complete Achilles tendon rupture. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. The search for randomised and observational comparative studies was performed through PubMed, Embase, Cochrane Library, Web of Science and Scopus databases and the first 200 records of Google Scholar without language or date restrictions. Studies comparing early and delayed surgical repair in adult patients were included. Data extraction and risk of bias assessment were carried out by two independent reviewers. Overall complications were pooled as Mantel–Haenszel odds ratio, and heterogeneity was measured using I². Results: Five non-randomised comparative cohort studies (359 early repairs and 249 delayed repairs) were analysed. In general, the rate of complications was found to be 12.8% for early repairs and 14.1% for delayed repairs (OR 0.74, 95% CI 0.45–1.23; I² = 54%). This was a non-statistically significant difference and favoured early repair. The analysis was mostly dependent on one study. Re-ruptures were registered in one study, and the number of events was 13 for the acute, delayed, and chronic groups, and none for the subacute group. The primary outcome measure, the Achilles Tendon Total Rupture Score, was not pooled. Conclusion: Early repair within 14 days was not significantly associated with fewer postoperative complications than delayed repair, although the point estimate favoured early surgery. The evidence is limited by small, mostly retrospective studies and moderate heterogeneity. Prospective studies with standardised timing categories and patient-reported outcomes are needed.