Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play

Abstract

Aim: This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP.

Design: A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination.

Data sources: PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles.

Eligibility criteria for selecting studies: Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included.

Results: 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001).

Conclusions: 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.

Keywords: Achilles; Achilles tendon; Assessment; Physical activity; Sport.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1

Decision tree for inclusion/exclusion of studies.

Figure 2

Rate of Return to Play (RTP) in Group 1 studies reporting percent RTP. Error bars indicate 95% confidence intervals, square markers indicate proportion of patients able to return to play reported in each study. The diamond marker and vertical line indicate the proportion of patients able to return to play in all Group 1 studies combined.

Figure 3

Rate of Return to Play (RTP) in Group 2 studies reporting percent RTP. Error bars indicate 95% confidence intervals, square markers indicate proportion of patients able to return to play reported in each study. The diamond marker and vertical line indicate the proportion of patients able to return to play in all Group 2 studies combined.

Figure 4

Time to Return to Play (RTP). Forest plot of time to return to play in months. Error bars indicate range as that was the most commonly reported measure of variance. Six studies reported a range without a mean and appear with only bars indicating reported range. The vertical line indicates the group mean for all studies reporting mean with measure of variance for time to return to play. Group 1 studies are indicated with squares for means, Group 2 studies are indicated with circles for means. Studies are ordered by RTP methodology group, then by number of patients with studies larger number of patients higher on the y-axis.