Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair

Abstract

Background: There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques. Methods: A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry. Demographics and complications were recorded. Results: PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection). Conclusion: Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences. Level of Evidence: Level III, retrospective cohort study.

Contemporary Review: An Overview of the Utility of Patient-Reported Outcome Measurement Information System (PROMIS) in Foot and Ankle Surgery

“…Furthermore, through improvements between preoperative and postoperative PROMIS scores, this study demonstrated responsiveness in PROMIS after both open and MIS repair, suggesting that both groups have similar long-term outcomes. 6 Another study demonstrated responsiveness between preoperative and postoperative PROMIS PF CAT and PI CAT scores among 62 patients with ruptured Achilles tendon who underwent surgery, suggesting the validity of PROMIS to evaluate Achilles tendon rupture treatment options. However, improvements in PROMIS scores did not automatically translate to clinically meaningful changes, as only 47% of patients in the Achilles PROMIS PF CAT domain achieved MCID of 3.0 to 4.5.…”

Traditional Open Repair and Reconstruction of Achilles Tendon Rupture

“…Overall, open Achilles tendon repair provides adequate restoration of tendon tension and plantarflexion strength, low rerupture and sural nerve injury rates, return to activity and improvement in patient-reported outcomes (PROs) 30–32 . Outcomes after open Achilles tendon repair are comparable to other treatment modalities, such as minimally invasive techniques or nonoperative management.…”

“…25 Overall, open Achilles tendon repair provides adequate restoration of tendon tension and plantarflexion strength, low rerupture and sural nerve injury rates, return to activity and improvement in patient-reported outcomes (PROs). [30][31][32] Outcomes after open Achilles tendon repair are comparable to other treatment modalities, such as minimally invasive techniques or nonoperative management. Although much of the literature has shown no differences in complication rates among surgical techniques and nonoperative management, the main differences to consider are possible increased risk of wound complications with open repair, decreased rerupture risk with surgery compared with nonoperative treatment, and decreased risk of sural nerve injury with open and nonoperative treatment compared with percutaneous minimally invasive approaches.…”

“…Although much of the literature has shown no differences in complication rates among surgical techniques and nonoperative management, the main differences to consider are possible increased risk of wound complications with open repair, decreased rerupture risk with surgery compared with nonoperative treatment, and decreased risk of sural nerve injury with open and nonoperative treatment compared with percutaneous minimally invasive approaches. [30][31][32] Open repair has demonstrated higher rates of superficial infection (6% vs. 0.4%, OR 5.7), 30,33,34 delayed wound healing (8.3% vs. 0%), 35 and adhesions (15.3% vs. 2.9%) 35 compared with minimally invasive approaches. Rerupture rates are generally low, but significant differences between nonoperative (3.9% to 6.2%) and operative (0.6% to 2.3%) management have been reported.…”

“…Outcomes after open Achilles tendon repair are comparable to other treatment modalities, such as minimally invasive techniques or nonoperative management. Although much of the literature has shown no differences in complication rates among surgical techniques and nonoperative management, the main differences to consider are possible increased risk of wound complications with open repair, decreased rerupture risk with surgery compared with nonoperative treatment, and decreased risk of sural nerve injury with open and nonoperative treatment compared with percutaneous minimally invasive approaches 30–32 . Open repair has demonstrated higher rates of superficial infection (6% vs. 0.4%, OR 5.7), 30,33,34 delayed wound healing (8.3% vs. 0%), 35 and adhesions (15.3% vs. 2.9%) 35 compared with minimally invasive approaches.…”