Outcomes Following Repair of Achilles Midsubstance Tears: Percutaneous Knotless Repair vs Open Repair

Abstract

Background: Optimum treatment for acute Achilles tendon rupture results in high mechanical strength, low risk of complications, and return to preinjury activity level. Percutaneous knotless repair is a minimally invasive technique with promising results in biomechanical studies, but few comparison clinical studies exist. Our study purpose was to compare functional outcomes and revision rates following acute Achilles tendon rupture treated between percutaneous knotless repair and open repair techniques. Methods: Patients 18 years or older with an acute Achilles tendon rupture, treated by a single surgeon with either open repair or percutaneous knotless repair, and more than 2 years after surgery were assessed for eligibility. Prospective clinical data were obtained from the data registry and standard electronic medical record. Additionally, the patients were contacted to obtain current follow-up questionnaires. Primary outcome measure was Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL). Secondary outcome measures were FAAM sports, 12-Item Short Form Health Survey (SF-12), Tegner activity scale, patient satisfaction with outcome, complications, and revisions. Postoperative follow-up closest to 5 years was used in this study. Results: In total, 61 patients were included in the study. Twenty-four of 29 patients (83%) in the open repair group and 28 of 32 patients (88%) in the percutaneous knotless repair group completed the questionnaires with average follow-up of 5.8 years and 4.2 years, respectively. We found no significant differences in patient-reported outcomes or patient satisfaction between groups (FAAM ADL: 99 vs 99 points, P = .99). Operative time was slightly longer in the percutaneous knotless repair group (46 vs 52 minutes, P = .02). Two patients in the open group required revision surgery compared to no patients in the percutaneous group. Conclusion: In our study, we did not find significant differences in patient-reported outcomes or patient satisfaction by treating Achilles tendon midsubstance ruptures with percutaneous knotless vs open repair. Level of Evidence: Level IlI, retrospective cohort study.

Acute Bilateral Achilles Tendon Rupture in a Middle-Aged Patient: A Rare but Debilitating Injury

“…Clinical outcomes of unilateral AT rupture are generally favorable, with successful surgical repair resulting in complete restoration of function and resolution of symptoms in most patients [ 15 ]. However, the outcomes of bilateral ruptures are more variable, as they can be complicated by additional factors such as muscle weakness, gait abnormalities, and compensatory mechanisms.…”

2023 Evidence-Based Medicine (EBM) Update

“…In a Level III retrospective cohort study, Stake et al 38 compared functional outcomes and revision rates following acute ATRs treated with open repair (32 patients) vs percutaneous knotless repair with suture anchors into the calcaneus (29 patients). At an average follow-up of more than 4 years with a greater than 80% response rate, there were no significant differences in patient-reported outcomes nor patient satisfaction (FAAM ADL: 99 vs 99 points, P = .99).…”