Abstract
Background
Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair.
Questions/purposes
We compared the two types of repairs in terms of (1) function (muscle strength, ankle ROM, calf and ankle perimeter, single heel rise tests, and work return), (2) cosmesis (length scar, cosmetic appearance), and (3) complications.
Patients and Methods
We retrospectively reviewed 32 surgically treated patients with Achilles rupture: 17 with percutaneous repair and 15 with open repair. All patients followed a standardized rehabilitation protocol. The minimum followup was 6 months (mean, 18 months; range, 6–48 months).
Results
We observed similar values of plantar flexor strength, ROM, calf and ankle perimeter, and single heel raising test between the groups. Mean time to return to work was longer for patients who had open versus percutaneous repair (5.6 months versus 2.8 months). Mean scar length was greater in the open repair group (9.5 cm versus 2.9 cm). Cosmetic appearance was better in the percutaneous group. Two wound complications and one rerupture were found in the open repair group. One case of deep venous thrombosis occurred in the percutaneous repair group. All complications occurred before 6 months after surgery. We identified no patients with nerve injury.
Conclusions
Percutaneous repair provides function similar to that achieved with open repair, with a better cosmetic appearance, a lower rate of wound complications, and no apparent increase in the risk of rerupture.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Aktas S, Kocaoglu B. Open versus minimal repair with Achillon device. Foot Ankle Int. 2009;30:391–397.
Amlang MH, Christiani P, Heinz P, Zwipp H. Percutaneous technique for Achilles tendon repair with the Dresden Instruments [in German]. Unfallchirurg. 2005;108:529–536.
Amlang MH, Christiani P, Heinz P, Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden Instrument [in German and English]. Oper Orthop Traumatol. 2006;18:287–299.
Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P. Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002;84:161–170.
Bradley JP, Tibone JE. Percutaneous and open repairs of Achilles tendon ruptures. Am J Sports Med. 1990;18:188–195.
Buchgraber A, Pässler HH. Percutaneous repair of Achilles tendon rupture: immobilization versus functional postoperative treatment. Clin Orthop Relat Res. 1997;341:113–122.
Carden DG, Noble J, Chalmers J, Lunn P, Ellis J. Rupture of the calcaneal tendon: the early and late management. J Bone Joint Surg Br. 1987;69:416–420.
Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg Br. 1989;71:100–101.
Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2008;16:204–209.
Gillies H, Chalmers J. The management of fresh ruptures of the tendo Achilles. J Bone Joint Surg Am. 1970;52:337–343.
Goren D, Ayalon M, Nyska M. Isokinetic strength and endurance after percutaneous and open surgical repair of Achilles tendon ruptures. Foot Ankle Int. 2005;26:286–290.
Gorschewsky O, Pitzl M, Putz A, Klakow A, Neumann W. Percutaneous repair of acute Achilles tendon rupture. Foot Ankle Int. 2004;25:219–224.
Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendo Achilles repair. Foot Ankle Int. 2004;25:215–218.
Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 1978;6:107–111.
Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2004;3:CD003674.
Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov. 1991;76:223–228.
Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–790.
Lea RB, Smith L. Non-surgical treatment of tendo Achilles rupture. J Bone Joint Surg Am. 1972;54:1398–1407.
Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:277–279.
Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon. Foot Ankle Int. 2001;22:559–565.
Maes R, Copin G. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg. 2006;72:179–183.
Maffulli N. Current Concepts Review: Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81:1019–1036.
Majewski M, Rohrbach M, Czaja S, Ochsner P. Avoiding sural nerve injuries during percutaneous Achilles tendon repair Am J Sports Med. 2006;34:793–798.
Moller A, Astrom M, Westlin NE. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–481.
Nilsson-Helander K, Thurin A, Karlsson J, Eriksson BI. High incidence of deep venous trombosis after Achilles tendon rupture: a prospective study. Knee Surg Sports Traumatol Arthrosc. 2009;17:1234–1238.
Pässler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol. 1998;14:93–95.
Rippstein PF, Jung M, Assal M. Surgical repair of acute Achilles tendon rupture using a ‘mini-open’ technique. Foot Ankle Clin. 2002;7:611–619.
Rowley DI, Scotland TR. Rupture of the Achilles tendon treated by a simple operative procedure. Injury. 1982;14:252–254.
Suchak A, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 2005;26:932–936.
Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–880.
Winter E, Weise K, Weller S, Ambacher T. Surgical repair of Achilles tendon rupture: comparison of surgical with conservative treatment. Arch Orthop Trauma Surg. 1998;117:364–367.
Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–575.
Zwipp H, Südkamp N, Thermann H, Samek N. Rupture of the Achilles tendon: results of 10 years’ follow-up after surgical treatment. A retrospective study [in German]. Unfallchirurg. 1989;92:554–559.
Acknowledgments
The authors thank Marcos Paleo Pineda who was chief of the foot and ankle service and operated on several patients; Leonardo Lagos Sepúlveda for checking and evaluating some of the patients; Juan Pablo Araya who was our physiotherapist; and Viviana Toro Ibacache who corrected the manuscript and helped us with the analyses.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.
About this article
Cite this article
Henríquez, H., Muñoz, R., Carcuro, G. et al. Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?. Clin Orthop Relat Res 470, 998–1003 (2012). https://doi.org/10.1007/s11999-011-1830-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-011-1830-1