Summary

Increased time to surgery may be predictive of postoperative complications following Achilles rupture repairs.

Abstract

Introduction

Achilles tendon ruptures are a common lower extremity orthopedic injury, often found in younger patients and sports-related contexts. Open and percutaneous repair techniques are both broadly applied in orthopedic practice, but there is not extensive literature available comparing both techniques that includes both complications and patient-reported outcomes. While Achilles repair often result in high patient satisfaction and good outcomes following surgery, complications can delay the healing process and even lead to reoperation.

Objective

The objective of this study was to determine if open versus closed surgical technique and time to surgery were related to postoperative complications. We hypothesized that an open surgical technique and increased time to surgery would correlate with an increase in complications.

Methods

Following IRB approval, patients at a single institution who underwent Achilles rupture repair surgery between October 2016 and March 2022 were retrospectively reviewed. All patients had a minimum follow-up of 3 months ± 14 days. Patient charts were assessed to collect data such as injury and treatment timepoints, surgical technique (open or percutaneous), and complications. Patients were separated into 3 categories based on time to surgery: acute (<2 weeks), sub-acute (2-6 weeks), and chronic (>6 weeks). Complications were categorized as minor (wounds and/or infections that resolved with outpatient care), major (wounds and/or infections requiring operative intervention), re-rupture, DVT, and all other complications. A Fisher’s exact test was used to determine if there was a statistically significant relationship between time to surgery and post-surgical complications as well as surgical technique and post-surgical complications.

Results

Evaluating the 359 patients included for analysis, we found that 74% of injuries occurred during a sports-related activity, the most common sport being basketball (18%). 174 were treated using an open technique (48%) and 185 were treated percutaneously (52%). 262 patients were treated after an acute rupture (73%), 65 after sub-acute (18%), and 32 chronic (9%). Total OR time was significantly longer for the open technique (average 69 min) compared to the percutaneous technique (56 min, p < 0.001). 66 complications were observed in 58 patients (16% of patients); 15 patients had a minor complication (4%), 8 major (2%), 13 re-ruptures (4%), 15 DVTs (4%), and 14 others (4%). While there were no statistical differences between groups comparing time to surgery or surgical technique, there was an increase in complications in the chronic group. Notably, re-rupture rate in the chronic group was 6%, compared to 4% and 2% in the acute and sub-acute groups, respectively.

Conclusion

We found that patients undergoing percutaneous and open repairs have similar outcomes, but percutaneous repairs are on average shorter procedures. Though not statistically significant, complications and re-ruptures were more frequent in patients undergoing surgery >6 weeks following injury. These results suggest increased time to surgery may be a predictor of increased risk for postoperative complications following Achilles repair surgery, however further research including studies with larger patient populations is needed to support this determination.