Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2015; 6(6): 491-497
Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.491
Analysing the outcome of surgery for chronic Achilles tendinopathy over the last 50 years
Wasim S Khan, Seema Malvankar, Jagmeet S Bhamra, Ioannis Pengas
Wasim S Khan, Seema Malvankar, Jagmeet S Bhamra, Ioannis Pengas, University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London HA7 4LP, United Kingdom
Author contributions: Khan WS and Malvankar S analysed the literature; Malvankar S wrote the preliminary draft of the manuscript and Khan WS revised the paper; Bhamra JS and Pengas I supervised the project and critically reviewed the draft; all authors approved the final submitted version of the manuscript.
Conflict-of-interest statement: None.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Dryad repository.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Wasim S Khan, Clinical Lecturer, University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London HA7 4LP, United Kingdom. wasimkhan@doctors.org.uk
Telephone: +44-79-71190720 Fax: +44-20-85703864
Received: February 23, 2015
Peer-review started: February 25, 2015
First decision: April 10, 2015
Revised: May 6, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: July 18, 2015
Processing time: 141 Days and 12.1 Hours
Abstract

AIM: To determine an association between when the study was performed, the robustness of the study and the outcomes for insertional and non-insertional Achilles tendinopathy surgery.

METHODS: We performed a systematic review in accordance with the PRISMA guidelines to assess the methodology of studies investigating the outcome of surgery in chronic Achilles tendinopathy over the last 50 years to identify any trends that would account for the variable results. The Coleman Methodology Scores were correlated with the reported percentage success rates and with the publication year to determine any trends using Pearson’s correlation.

RESULTS: We identified 62 studies published between 1964 and 2014 reporting on a total of 2923 surgically treated Achilles tendinopathies. The average follow-up time was 40 mo (range 5-204 mo), and the mean reported success rate was 83.5% (range 36%-100%). The Coleman Methodology Scores were highly reproducible (r = 0.99, P < 0.01), with a mean of 40.1 (SD 18.9, range 2-79). We found a negative correlation between reported success rate and overall methodology scores (r = -0.40, P < 0.001), and a positive correlation between year of publication and overall methodology scores (r = 0.46, P < 0.001).

CONCLUSION: We conclude that although the success rate of surgery for chronic Acilles tendinopathy described in the literature has fallen over the last 50 years, this is probably due to a more rigorous methodology of the studies.

Keywords: Achilles tendon; Surgery; Methodology; Outcome; Tendinopathy

Core tip: Although the success rate of surgery for chronic Acilles tendinopathy described in the literature has fallen over the last 50 years, this is probably due to a more rigorous methodology of the studies. Future studies with more robust methodologies will hopefully address some of the unanswered questions in the surgical management of this difficult condition.