Percutaneous versus open repair of acute Achilles tendon ruptures

  • Panagiotis K. Karabinas
  • Ioannis S. Benetos
  • Kalliopi Lampropoulou-Adamidou
  • Pavlos Romoudis
  • Andreas F. Mavrogenis
  • John Vlamis
Original Article



Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures.

Materials and methods

We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10–24 months) for the open repair group and 20 months (range 9–24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients’ return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded.


No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7–9 weeks. The mean time of patients’ return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study.


The present study showed similarly successful clinical and functional results after both open and percutaneous repair of acute Achilles tendon ruptures are similar. Cosmetic appearance is superior in the group of patients who had a percutaneous treatment.


Achilles tendon rupture Percutaneous repair Open repair 


  1. 1.
    Raikin SM, Garras DN, Krapchev PV (2013) Achilles tendon injuries in a United States population. Foot Ankle Int 34(4):475–480PubMedCrossRefGoogle Scholar
  2. 2.
    Deangelis JP, Wilson KM, Cox CL, Diamond AB, Thomson AB (2009) Achilles tendon rupture in athletes. J Surg Orthop Adv 18(3):115–121PubMedGoogle Scholar
  3. 3.
    Azar FM (2008) Rupture of muscles and tendons. Achilles tendon injuries. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, vol 3, 11th edn. Mosby Elsevier, China, pp 2748–2753Google Scholar
  4. 4.
    Cretnik A, Kosanovic M, Smrkolj V (2004) Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg 43(2):72–81PubMedCrossRefGoogle Scholar
  5. 5.
    Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H (2012) MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res 470(8):2268–2273PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Feldbrin Z, Hendel D, Lipkin A, Zin D, Schorr L (2010) Achilles tendon rupture and our experience with the Achillon device. Isr Med Assoc J 12(10):609–612PubMedGoogle Scholar
  7. 7.
    Davies MS, Solan M (2009) Minimal incision techniques for acute Achilles repair. Foot Ankle Clin 14(4):685–697PubMedCrossRefGoogle Scholar
  8. 8.
    Jiang N, Wang B, Chen A, Dong F, Yu B (2012) Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 36(4):765–773 Google Scholar
  9. 9.
    Wilkins R, Bisson LJ (2012) Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med 40(9):2154–2160Google Scholar
  10. 10.
    Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, Watters WC 3rd, Goldberg MJ, Keith M, Haralson RH III, Turkelson CM, Wies JL, Raymond L, Anderson S, Boyer K, Sluka P (2010) Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg 18(8):503–510PubMedGoogle Scholar
  11. 11.
    Olsson N, Nilsson-Helander K, Karlsson J, Eriksson BI, Thomee R, Faxen E, Silbernagel KG (2011) Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 19(8):1385–1393Google Scholar
  12. 12.
    Horstmann T, Lukas C, Merk J, Brauner T, Mundermann A (2012) Deficits 10-years after Achilles tendon repair. Int J Sports Med 33(6):474–479Google Scholar
  13. 13.
    Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M (2005) Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 87(10):2202–2210PubMedCrossRefGoogle Scholar
  14. 14.
    Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U (1993) Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med 21(6):791–799PubMedCrossRefGoogle Scholar
  15. 15.
    McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg 17(4):211–217Google Scholar
  16. 16.
    Saxena A, Maffulli N, Nguyen A, Li A (2008) Wound complications from surgeries pertaining to the Achilles tendon: an analysis of 219 surgeries. J Am Podiatr Med Assoc 98(2):95–101PubMedGoogle Scholar
  17. 17.
    Webb JM, Bannister GC (1999) Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br 81(5):877–880PubMedCrossRefGoogle Scholar
  18. 18.
    Maes R, Copin G, Averous C (2006) Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 72(2):179–183PubMedGoogle Scholar
  19. 19.
    Thompson TC (1962) A test for rupture of the tendo achillis. Acta Orthop Scand 32:461–465PubMedCrossRefGoogle Scholar
  20. 20.
    Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68(5):764–766PubMedGoogle Scholar
  21. 21.
    Ma GW, Griffith TG (1977) Percutaneous repair of acute closed ruptured Achilles tendon: a new technique. Clin Orthop Relat Res 128:247–255PubMedGoogle Scholar
  22. 22.
    Talbot JC, Williams GT, Bismil Q, Shaw DL, Schilders E (2012) Results of accelerated postoperative rehabilitation using novel “suture frame” repair of Achilles tendon rupture. J Foot Ankle Surg 51(2):147–151Google Scholar
  23. 23.
    Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353PubMedCrossRefGoogle Scholar
  24. 24.
    Maffulli N, Longo UG, Ronga M, Khanna A, Denaro V (2010) Favorable outcome of percutaneous repair of Achilles tendon ruptures in the elderly. Clin Orthop Relat Res 468(4):1039–1046PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Movin T, Ryberg A, McBride DJ, Maffulli N (2005) Acute rupture of the Achilles tendon. Foot Ankle Clin 10(2):331–356PubMedCrossRefGoogle Scholar
  26. 26.
    Carmont MR, Heaver C, Pradhan A, Mei-Dan O, Gravare Silbernagel K (2013) Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair. Knee Surg Sports Traumatol Arthrosc 21(6):1361–1368Google Scholar
  27. 27.
    Kolodziej L, Bohatyrewicz A, Kromuszczynska J, Jezierski J, Biedron M (2013) Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study—preliminary report. Int Orthop 37(4):625–629Google Scholar
  28. 28.
    Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N (2013) Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon 11(1):14–19Google Scholar
  29. 29.
    Blankstein A, Israeli A, Dudkiewicz I, Chechik A, Ganel A (2007) Percutaneous Achilles tendon repair combined with real-time sonography. Isr Med Assoc J 9(2):83–85PubMedGoogle Scholar
  30. 30.
    Delponte P, Potier L, de Poulpiquet P, Buisson P (1992) Treatment of subcutaneous ruptures of the Achilles tendon by percutaneous tenorrhaphy. Rev Chir Orthop Reparatrice Appar Mot 78(6):404–407PubMedGoogle Scholar
  31. 31.
    Soubeyrand M, Serra-Tosio G, Campagna R, Molina V, Sitbon P, Biau DJ (2010) Intraoperative ultrasonography during percutaneous Achilles tendon repair. Foot Ankle Int 31(12):1069–1074PubMedCrossRefGoogle Scholar
  32. 32.
    Goren D, Ayalon M, Nyska M (2005) Isokinetic strength and endurance after percutaneous and open surgical repair of Achilles tendon ruptures. Foot Ankle Int 26(4):286–290PubMedGoogle Scholar
  33. 33.
    Rosso C, Vavken P, Polzer C, Buckland DM, Studler U, Weisskopf L, Lottenbach M, Muller AM, Valderrabano V (2013) Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc 21(6):1369–1377Google Scholar
  34. 34.
    Lim J, Dalal R, Waseem M (2001) Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int 22(7):559–568PubMedGoogle Scholar
  35. 35.
    Ceccarelli F, Berti L, Giuriati L, Romagnoli M, Giannini S (2007) Percutaneous and minimally invasive techniques of Achilles tendon repair. Clin Orthop Relat Res 458:188–193PubMedGoogle Scholar
  36. 36.
    Carmont MR, Maffulli N (2008) Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc 16(2):199–203PubMedCrossRefGoogle Scholar
  37. 37.
    Wong J, Barrass V, Maffulli N (2002) Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med 30(4):565–575PubMedGoogle Scholar
  38. 38.
    Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N (2013) Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon 11(1):14–19Google Scholar
  39. 39.
    Nestorson J, Movin T, Moller M, Karlsson J (2000) Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years. Acta Orthop Scand 71(1):64–68PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Panagiotis K. Karabinas
    • 1
  • Ioannis S. Benetos
    • 1
  • Kalliopi Lampropoulou-Adamidou
    • 1
  • Pavlos Romoudis
    • 1
  • Andreas F. Mavrogenis
    • 2
  • John Vlamis
    • 1
  1. 1.Third Department of OrthopaedicsAthens University Medical SchoolAthensGreece
  2. 2.First Department of OrthopaedicsAthens University Medical School, Attikon University HospitalAthensGreece

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