Current literature shows that minimally invasive (MIS) tendo-Achilles (TA) repairs carry a lower risk of infection compared to open repairs. Our study aimed to assess whether MIS TA repair also contributed to improved patient outcomes as well as lowered infection and wound complication rates. Between January 2017 and December 2019, 19 patients underwent minimally invasive TA repairs performed by two fellowship-trained foot and ankle surgeons at a tertiary institution. A retrospective review of registry data was performed. Outcomes were measured to include AOFAS Score, RAND36 Scores as well as patient-reported satisfaction scores and visual analog scale (VAS) for pain assessment. Statistical analysis was performed using a Student's t-test for continuous variables and Pearson's Chi-squared test for categorical variables. The overall results showed that patients who underwent MIS TA repair had much faster recovery when compared to traditional open TA repairs. Of the 19 patients who underwent MIS TA repair, there were two cases of superficial wound infection compared to six in the open group (p < 0.05). The MIS TA repair arm of the study also had higher patient-reported satisfaction rates, lower VAS pain scores (p < 0.05), with better AOFAS and SF36 quality of life measures. Overall, the rate of superficial infection, wound complication and length of stay were all reduced in the MIS group with similar deep infection rates. Our study concludes that where possible, TA rupture should be repaired minimally invasively and by an experienced foot and ankle surgeon as this will yield the best outcomes for the patient.
Level of evidence: III
Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 2012;36(4):765–773. DOI: 10.1007/s00264-011-1431-3.
Karabinas PK, Benetos IS, Lampropoulou-Adamidou K, et al. Percutaneous versus open repair of acute Achilles tendon ruptures. Eur J Orthop Surg Traumatol 2014;24(4):607–613. DOI: 10.1007/s00590-013-1350-7.
Khan RJK, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures: a meta-analysis of randomized, controlled trials. J Bone Jt Surg - Ser A 2005;87(10):2202–2210. DOI: 10.2106/JBJS.D.03049.
Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med 1999;9(3):157–160. DOI: 10.1097/00042752-199907000-00007.
Suchak AA, Bostick G, Reid D, et al. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int 2005;26(11):932–936. DOI: 10.1177/107110070502601106.
Martin RRL, Manning CM, Carcia CR, et al. An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer. Foot Ankle Int 2005;26(9):691–697. DOI: 10.1177/107110070502600905.
Tallon C, Maffulli N, Ewen SWB. Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons. Med Sci Sports Exerc 2001;33(12):1983–1990. DOI: 10.1097/00005768-200112000-00002.
Sorrenti SJ. Achilles tendon rupture: Effect of early mobilization in rehabilitation after surgical repair. Foot Ankle Int 2006;27(6):407–410. DOI: 10.1177/107110070602700603.
Yang B, Liu Y, Kan S, et al. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: a meta-analysis. Int J Surg 2017;40:178–186. DOI: 10.1016/j.ijsu.2017.03.021.
Zhang H, Tang H, He Q, et al. Surgical versus conservative intervention for acute achilles tendon rupture. Med (United States) 2015;94(45):e1951. DOI: 10.1097/MD.0000000000001951.
Gigante A, Moschini A, Verdenelli A, et al. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surgery, Sport Traumatol Arthrosc 2008;16(2):204–209. DOI: 10.1007/s00167-007- 0448-z.
Grassi A, Amendola A, Samuelsson K, et al. Minimally invasive versus open repair for acute Achilles tendon rupture. J Bone Jt Surg 2018;100(22):1969–1981. DOI: 10.2106/jbjs.17.01364.
Hsu AR, Jones CP, Cohen BE, et al. Clinical outcomes and complications of percutaneous achilles repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int 2015;36(11):1279–1286. DOI: 10.1177/1071100715589632.
VanderZee KI, Sanderman R, Heyink JW, et al. Psychometric qualities of the RAND 36-item health survey 1.0: a multidimensional measure of general health status. Int J Behav Med 1996;3(2):104–122. DOI: 10.1207/s15327558ijbm0302_2.
Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF. 2011;63(SUPPL. 11). Arthritis Care Res 2011(S11):240–252. DOI: 10.1002/acr.20543.
Price DD, McGrath PA, Rafii A, et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983;17(1):45–56. DOI: 10.1016/0304-3959(83)90126-4.
Manegold S, Tsitsilonis S, Schumann J, et al. Functional outcome and complication rate after percutaneous suture of fresh Achilles tendon ruptures with the dresden instrument. J Orthop Traumatol 2018;19(1):1–7. DOI: 10.1186/s10195-018-0511-1.
Hays RD, Sherbourne CD, Mazel RM. The rand 36-item health survey 1.0. Health Econ 1993;2(3):217–227. DOI: 10.1002/hec.4730020305.
VanderZee KI, Sanderman R, Heyink J. A comparison of two multidimensional measures of health status: the Nottingham health profile and the RAND 36-Item health survey 1.0. Qual Life Res 1996;5(1):165–174. DOI: 10.1007/BF00435982.
Daghino W, Enrietti E, Sprio AE, et al. Subcutaneous Achilles tendon rupture: a comparison between open technique and mini-invasive tenorrhaphy with Achillon® suture system. Injury 2016;47(11): 2591–2595. DOI: 10.1016/j.injury.2016.09.009.
Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med 2002;30(4):565–575. DOI: 10.1177/03635465020 300041701.
Garrick JG. Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute achilles tendon ruptures? Clin J Sport Med 2012;22(4):378–379. DOI: 10.1097/JSM.0b013e3182603905.
Olsson N, Silbernagel KG, Eriksson BI, et al. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute achilles tendon ruptures: a randomized controlled study. Am J Sports Med 2013;41(12):2867–2876. DOI: 10.1177/0363546513503282.
Wilkins R, Bisson LJ. Operative versus nonoperative management of acute achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med 2012;40(9):2154–2160. DOI: 10.1177/0363546512453293.
Zgonis T, Jolly GP, Garbalosa JC. The efficacy of prophylactic intravenous antibiotics in elective foot and ankle surgery. J Foot Ankle Surg 2004;43(2):97–103. DOI: 10.1053/j.jfas.2004. 01.003.
Marican MM, Fook-Chong SMC, Rikhraj IS. Incidence of postoperative wound infections after open tendo achilles repairs. Singapore Med J 2015;56(10):549–554. DOI: 10.11622/smedj.2015150.
Highlander P, Greenhagen RM. Wound complications with posterior midline and posterior medial leg incisions: a systematic review. Foot Ankle Spec 2011;4(6):361–369. DOI: 10.1177/1938640011418488.
Ademoğlu Y, Özerkan F, Ada S, et al. Reconstruction of skin and tendon defects from wound complications after Achilles tendon rupture. J Foot Ankle Surg 2001;40(3):158–165. DOI: 10.1016/S1067-2516(01)80082-X.
Attinger CE, Evans KK, Bulan E, et al. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg 2006;117(7 SUPPL.):261–293. DOI: 10.1097/01.prs.0000222582. 84385.54.
Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987;40(2):113–141. DOI: 10.1016/0007-1226(87)90185-8.