Comparative effectiveness of weight-bearing strategies on functional recovery in acute Achilles tendon rupture: A network meta-analysis.

Objective: Evaluation of the impact of early weight-bearing on intervention to assess functional outcomes following acute Achilles tendon rupture.

Methods: A systematic literature search was conducted following PRISMA guidelines including RCTs involving adult patients with AATR. Interventions were coded based on management approach and weight-bearing strategy: Open, Minimally Invasive, Percutaneous, and Conservative approach, with Early Weightbearing and Late Weightbearing. Outcomes included Achilles Tendon Rupture Score, re-rupture, total complications, return to work, and heel-raise functionality. A frequentist network meta-analysis using fixed-effects models was employed, with sensitivity analysis to assess robustness.

Results: A total of 29 RCTs with 2549 patients were included. OR+LW showed significant improvement in early ATRS compared to OR+EW (MD -2.95 [95 % CI, -4.59; -1.31]). MI+EW was identified as the most suitable intervention for improving late ATRS (MD 4.21 [95 % CI, 0.94; 7.49]). MI+LW demonstrated the lowest incidence of re-rupture (OR 0.10 [95 % CI, 0.01; 0.80]). OR+LW was associated with better heel-raise (MD -7.97 [95 % CI, -9.72; -6.22]). Return to work was significantly quicker with MI+EW (SMD -2.53 [95 % CI, -3.34; -1.71]). No significant differences in total complications were found among the interventions.

Conclusion: The study highlights the importance of weight-bearing timing in AATR rehabilitation. OR+LW was beneficial for early ATRS and heel-raise, while MI+EW was optimal for late ATRS and quicker return to work. MI+LW showed the lowest re-rupture rates. Despite variability in outcomes, no single intervention emerged as superior across all measures, emphasizing the need for individualized treatment approaches to achieve optimal functional outcomes.