Summary

All three surgical techniques are safe and equally effective in treating acute Achilles tendon ruptures showing comparable clinical and functional outcomes are similar between open, mini-open and percutaneous repair. Percutaneous surgery allows a faster return to work and should be considered by the orthopaedic surgeon when operating patients with acute Achilles tendon rupture.

Abstract

Background

Surgical treatment of Achilles tendon ruptures has shown lower re-rupture rates and better functional outcomes as compared to conservative approaches. In athletes, the surgical treatment is preferred to withstand the high demands of sports and allow a faster return to competition. There are several approaches to repair the Achilles tendon, including the open, mini-open or percutaneous techniques. However, there is no consensus on which provides better outcomes. The aim of this study is thus to compare the clinical, functional and patient-reported outcome measures of open, mini-open or percutaneous repair techniques.

Methods

Retrospective multicentric cohort study to evaluate clinical, functional and patient-reported outcome measures after open, mini-open or percutaneous repair of the Achilles tendon. We included adult patients (= 18 years old at the time of surgery) with a diagnosis of acute Achilles tendon rupture that was surgically treated with open, mini-open or percutaneous repair technique. The exclusion criteria were defined as: treatment of a re-rupture or chronic rupture (more than 4 weeks without treatment) of the Achilles tendon; less than 24 months follow-up; patients with diagnosis of diabetes mellitus or rheumatoid arthritis; patients with immunosuppression or under renal dialysis; patients that deceased during the time of the follow-up, that refused to participate in this study or were unable to be contacted; and when there was fundamental baseline information missing. The Achilles Tendon Rupture Score (ATRS), time to return to work, time to return to sports, and complications (re-ruptures, infections and sural nerve lesions) incidence were recorded. The ATRS was also assessed according the follow-up duration (<5 vs =5 years). Clinical and functional outcomes were compared between groups with Kruskal Wallis or One-Way ANOVA according normality distribution. A pairwise comparison using the Bonferroni correction was used for those outcomes that were statistically different across the three groups. Linear regression models were generated to determine prognostic predictors (baseline clinical and demographic characteristics) of return to work, return to sports and ATRS.

Results

A total of 63 acute Achilles ruptures operated from 2008 to 2018 (22 open, 27 mini-open and 14 percutaneous), with a mean 38.22 ± 8.46 years and a median 7.0 years of were included for analysis. All patient demographics were homogenous across groups. Percutaneous repair allowed a faster return to work as compared to open (p=0.004) and mini-open (p=0.044) techniques. No significant differences were observed in the time to return to sports, complications, re-ruptures, infections, sural nerve lesions and ATRS between the three groups. The percutaneous technique was identified as a prognostic factor for faster return to work. The average time to return to work decreases 14.11 weeks when using the percutaneous technique.

Conclusions

All three surgical techniques are safe and equally effective in treating acute Achilles tendon ruptures showing comparable clinical and functional outcomes are similar between open, mini-open and percutaneous repair. Percutaneous repair allows a faster return to work for patients with acute Achilles tendon rupture and should be considered by the orthopaedic surgeon when operating patients with acute Achilles tendon rupture.