Retrospective Comparison of Complications with Open versus Minimally Invasive Achilles Tendon Repair

Abstract

Category: Sports; Other Introduction/Purpose: Despite the relatively high frequency of Achilles ruptures, there is no clear consensus on the optimal treatment method. The debate has traditionally been framed by the tension between the risk for rerupture seen with nonoperative treatment and the risk for wound issues seen with operative treatment. Studies have demonstrated conflicting results when comparing complications associated with each treatment. The current study analyzed complications of patients with Achilles tendon ruptures that received either minimally invasive repair or open standard repair by a single surgeon. Methods: We conducted a retrospective chart review of patients that had Achilles tendon repair performed by the senior author between July 1st 2011 and January 22nd 2020. The senior author’s preferred operative technique transitioned from an open standard procedure to a minimally invasive procedure within this time frame, and patients were divided accordingly. Patient demographics, medical history, social history, surgical details, and additional surgeries were recorded. Patient outcomes and any complications were also recorded. Complications included any wound related issues or infection, erythema, DVT, wound breakdown, drainage, equinus contracture, and calcaneus stress reaction. Pain, swelling and/or tenderness were not considered complications. Independent sample t-tests and chi-square analyses were conducted to assess for differences in patient demographics and operative outcomes between the minimally invasive and open procedure treatment groups. Results: Of the 127 included patients, 75.6% were male with an average age of 41.85 (+-14.02). 30 (23.6%) patients had the minimally invasive approach, while 97 (76.4%) had the open approach. 82.7% were non-smokers, and the average BMI was 31.47(+-29.84). A majority of injuries (63.8%) occurred while playing sports. There were 10 complications, all of which were wound-related and all of which were in the open group (p=0.06). There were no revision surgeries in the minimally invasive group, and 10 in the open group (p=0.06). There were no recorded reruptures in either group. Conclusion: This study sought to determine the complication profile of two operative treatments for Achilles tendon ruptures, open standard and minimally invasive repair. Recent literature has suggested that minimally invasive repair results in superior outcomes to open repair. Our study found that both repeat surgery and complications trended towards a higher rate following open repair compared to minimally invasive repair, although the difference was not statistically significant (p=0.06). It is notable, however, that there were fewer total patients in the minimally invasive group and that there was not a single wound complication in the minimally invasive group.