{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:55:03Z","timestamp":1792518903641,"version":"4.5.0"},"reference-count":98,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Both surgical and non\u2010surgical treatments for acute Achilles tendon ruptures (aATRs) exist, but the optimal management strategy, especially regarding weight\u2010bearing timing, remains unclear. This study investigates combinations of primary treatment (open surgical repair, percutaneous\/minimally invasive repair and non\u2010surgical treatment) and rehabilitation strategies (Early Weight Bearing [EWB] vs. Late Weight Bearing [LWB]) for aATRs, analysing re\u2010rupture risk, complication rates and recovery outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic review and network meta\u2010analysis registered in PROSPERO (CRD42023389413). Medline, Scopus, Web of Science, CINAHL, ClinicalTrials.gov, and Cochrane Library were searched for studies assessing primary treatments and rehabilitation strategies for aATR in adults (&gt;18\u2009years old) with at least six months of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010one studies (23 randomised\u2010controlled\u2010trials, 17 non\u2010randomised\u2010studies\u2010of\u2010intervention) comprising 5566 patients and 82 treatment arms were included. Network meta\u2010analysis was performed for re\u2010rupture risk and other outcomes, reporting odds ratios and treatment rankings. Open surgical repair combined with LWB has the lowest re\u2010rupture risk (2%, 95%CI 1%\u20133%). EWB facilitates faster recovery but marginally increases complication risks, though not statistically significant. Non\u2010surgical treatment shows a higher re\u2010rupture rate than surgical options (12% vs. 2%\/4%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Major wound complications are rare (2.8%), with percutaneous repair having a higher risk of sural nerve injury (4% vs. 1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.02). Deep vein thrombosis\/pulmonary embolism risk is higher with non\u2010surgical treatment (2% vs. 1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.04). EWB leads to faster return\u2010to\u2010sport and higher Achilles Tendon Rupture Scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Open surgical repair with LWB reduces re\u2010rupture risk, while EWB offers faster recovery and higher patient satisfaction. Non\u2010surgical treatment has the highest re\u2010rupture and DVT\/PE risk. Percutaneous repair increases sural nerve injury risk compared to open surgery, with no significant difference in wound complications. In patients with no contraindications, open surgical repair should be considered the gold standard, with no statistical difference in major and minor wound complications when compared to percutaneous treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level I.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12686","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T07:59:42Z","timestamp":1747641582000},"page":"2664-2683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Open surgical repair as gold standard for acute Achilles tendon ruptures: Systematic review and network meta\u2010analysis"],"prefix":"10.1002","volume":"33","author":[{"given":"Alessandro","family":"Pisano","sequence":"first","affiliation":[{"name":"Department of Neurosciences and Rehabilitation \u201cS. Anna\u201d University Hospital, University of Ferrara Ferrara Italy"},{"name":"Department of Education and Research, Isokinetic Medical Group FIFA Medical Centre of Excellence Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matias","family":"Boxler","sequence":"additional","affiliation":[{"name":"Universit\u00e4re Klinik f\u00fcr Orthop\u00e4die und Traumatologie, Universit\u00e4res Zentrum Bewegungsapparat, Kantonsspital Baselland Bruderholz BL Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Gambuti","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Rehabilitation \u201cS. Anna\u201d University Hospital, University of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Falco","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Rehabilitation \u201cS. Anna\u201d University Hospital, University of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Trierweiler","sequence":"additional","affiliation":[{"name":"Universit\u00e4re Klinik f\u00fcr Orthop\u00e4die und Traumatologie, Universit\u00e4res Zentrum Bewegungsapparat, Kantonsspital Baselland Bruderholz BL Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-7733","authenticated-orcid":false,"given":"Antonio","family":"Vinci","sequence":"additional","affiliation":[{"name":"Doctoral School in Nursing Sciences and Public Health University of Rome Tor Vergata Rome Italy"},{"name":"Health Management Unit Azienda Regionale Emergenza Sanitaria Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorian","family":"Bardhi","sequence":"additional","affiliation":[{"name":"Health Management Unit Azienda Ospedaliera Ospedali Riuniti Umberto I G.M. Lancisi G. Salesi Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Loreto","family":"D'Al\u00f2","sequence":"additional","affiliation":[{"name":"Health directorate Territorial District 6, Local Health Authority Roma 2 Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Maria","family":"Malerba","sequence":"additional","affiliation":[{"name":"School of Specialization in Hygiene and Preventive Medicine University of Rome Tor Vergata Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Grassi","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Ingravalle","sequence":"additional","affiliation":[{"name":"Doctoral School in Nursing Sciences and Public Health University of Rome Tor Vergata Rome Italy"},{"name":"Local Health Authority ASL Roma 1 Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Maurici","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12456"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00132-024-04556-w"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01273"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-008-0564-5"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2000-9591"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.imr.2023.101014"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2023.06.010"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2009.01973.x"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-024-04970-y"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.04.2020.13"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60091382"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604.ch11"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta24080"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B1.16549"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5049-5"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.30795\/jfootankle.2021.v15.1221"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2017.05.036"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-022-04535-w"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.7523"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518781826"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2024.1483584"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-024-01454-w"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-020-03461-z"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2014.03.010"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1150511"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.01.028"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-020-01376-3"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100714536167"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.0337"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-018-2940-y"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2022.12.006"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0347-z"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2024.04.005"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517694610"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07619-1"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"issue":"9","key":"e_1_2_14_38_1","article-title":"Interventions for maintenance of surgically induced remission in Crohn's disease: a network meta\u2010analysis","volume":"9","author":"Iheozor\u2010Ejiofor Z","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110070102201210"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2013.03.024"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118779862"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5058-4"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-10-24"},{"issue":"11","key":"e_1_2_14_44_1","article-title":"Traction sural neuropathy following nonoperative management of acute achilles tendon rupture: a case report","volume":"16","author":"Kim KJ","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-015-0710-z"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-023-05827-5"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-011-0867-x"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516651060"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118808238"},{"key":"e_1_2_14_50_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2022\/6795573","article-title":"Asymptomatic hyperuricemia is associated with Achilles tendon rupture through disrupting the normal functions of tendon stem\/progenitor cells","volume":"1","author":"Liang J","year":"2022","journal-title":"Stem Cells Int"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1177\/2309499020908354"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-016-1158-7"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241284644"},{"key":"e_1_2_14_54_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520944905"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06824-0"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2017.05.019"},{"issue":"3","key":"e_1_2_14_57_1","first-page":"367","article-title":"No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon","volume":"43","author":"Maffulli N","year":"2003","journal-title":"J Sports Med Phys Fitness"},{"key":"e_1_2_14_58_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638280701786831"},{"key":"e_1_2_14_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2018.04.004"},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2019.02.002"},{"key":"e_1_2_14_61_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-020-01477-z"},{"issue":"2","key":"e_1_2_14_62_1","first-page":"255","article-title":"Introduction to the operation room management technology: interrupted time series analysis in an urban acute care hospital facility in Rome, Italy","volume":"37","author":"Marte M","year":"2025","journal-title":"Annal Igiene: Med Prev Comun"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.1530\/EOR-22-0072"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1177\/23259671241279388"},{"key":"e_1_2_14_66_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-024-06362-7"},{"key":"e_1_2_14_67_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0838.2002.120103.x"},{"key":"e_1_2_14_68_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B6.0830843"},{"key":"e_1_2_14_69_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2018.12.024"},{"key":"e_1_2_14_70_1","doi-asserted-by":"publisher","DOI":"10.25259\/SNI_959_2021"},{"key":"e_1_2_14_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2012.01497.x"},{"key":"e_1_2_14_72_1","doi-asserted-by":"publisher","DOI":"10.1002\/cl2.1080"},{"key":"e_1_2_14_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12910"},{"key":"e_1_2_14_74_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715615322"},{"key":"e_1_2_14_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2024.08.024"},{"key":"e_1_2_14_76_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06580-1"},{"key":"e_1_2_14_77_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513501785"},{"key":"e_1_2_14_78_1","doi-asserted-by":"publisher","DOI":"10.1302\/2046-3758.118.BJR-2021-0576.R1"},{"key":"e_1_2_14_79_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07411-1"},{"key":"e_1_2_14_80_1","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2017047"},{"key":"e_1_2_14_81_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_14_82_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_14_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.06.005"},{"key":"e_1_2_14_84_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01242"},{"key":"e_1_2_14_85_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17134642"},{"key":"e_1_2_14_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.05.038"},{"key":"e_1_2_14_87_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0212650"},{"key":"e_1_2_14_88_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507307503"},{"key":"e_1_2_14_89_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0294785"},{"key":"e_1_2_14_90_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"key":"e_1_2_14_91_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6131"},{"key":"e_1_2_14_92_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.81B5.0810877"},{"key":"e_1_2_14_93_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.orthtr.2021.04.001"},{"key":"e_1_2_14_94_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01401"},{"key":"e_1_2_14_95_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-017-0362-x"},{"key":"e_1_2_14_96_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516685055"},{"key":"e_1_2_14_97_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02342-4"},{"key":"e_1_2_14_98_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00248"},{"key":"e_1_2_14_99_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100717742372"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12686","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T13:24:37Z","timestamp":1760880277000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":98,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/ksa.12686"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12686","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]},"assertion":[{"value":"2025-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}