Comparing Outcomes of Surgical and Nonsurgical Management for Achilles Tendon Ruptures: A Systematic Review and Meta-Analysis

Background: Achilles tendon rupture is a common injury, and the optimal management approach—surgical or conservative—remains debated. The current systematic review and meta-analysis aim to compare surgical and conservative management strategies, considering efficacy and safety, by assessing the functional outcomes, rate of complications, and rate of re-rupture. Methods: A comprehensive literature search was conducted across multiple electronic databases to identify eligible randomized controlled trials (RCTs) comparing surgical and conservative management of Achilles tendon rupture. The main key outcomes included Achilles Tendon Score (ATRS), Complications incidence, including the incidence of deep vein thrombosis (DVT). For meta-analysis, effect sizes, confidence intervals, and heterogeneity were calculated depending on a random-effects model. Results: The results of the current review showed a substantial advantage of surgical management showed a significant advantage in ATRS scores (pooled estimate: 2.241; 95% CI: 1.004–3.478; p < 0.001). Regarding safety, no significant difference was found in DVT incidence (pooled estimate: 0.460; 95% CI: 0.163–1.302; p = 0.144; I² = 0%); the surgical group showed a non-significant increase in infection rates (pooled estimate: 2.217; 95% CI: 0.763–6.446; p = 0.144; I² = 0%) and conservative management had a significantly higher rate of re-rupture (pooled estimate: 0.182; 95% CI: 0.085–0.391; p < 0.001; I² = 0%). Conclusion: Surgical management is associated with a lower risk of re-rupture, while both approaches yield comparable long-term functional outcomes.