Acute ruptures of the Achilles tendon are common and can lead to major functional limitations, with noticeable loss of strength and endurance. 1 Many such patients fail to resume sporting activities in the short term, and the injury produces ongoing problems even after 10 years. 2 Modern management aims to promptly maximise function and minimise complications. Much of recent research has tried to determine the optimal methods of either surgical or non-surgical treatment using a randomised controlled trial study design, with the primary outcome in most of such studies being the prevention of re-ruptures. In a linked systematic review and meta-analysis, Ochen and colleagues (doi:10.1136/bmj.k5120) carefully analysed 29 studies in this specialty, including 19 observational and 10 randomised controlled trials. 3
This rigorous work is to be commended. Ochen and colleagues’ investigation emphasises the importance of including high quality observational studies as …