Percutaneous versus open repair of the ruptured Achilles tendon - A comparative study

Background: Controversy regarding the optimal treatment of the fresh total Achilles tendon rupture remains. Purpose: To compare the results of percutaneous and open Achilles tendon repair. Study Design: Cohort study; Level of evidence, 2. Methods: The results of 132 consecutive patients with acute complete Achilles tendon rupture who were operated on exclusively with modified percutaneous repair under local anesthesia from 1991 to 1997 and followed up for at least 2 years were compared to the results of 105 consecutive patients who were operated on exclusively with open repair under general or spinal anesthesia in the same period. Results: There were significantly fewer major complications in the group of percutaneous repairs in comparison with the group of open repairs (4.5 % vs 12.4 %; P = .03), particularly necrosis (0 % vs 5.6 %; P = .019), and a lower total number of complications (9.7 % vs 21 %; P = .013). There were slightly more reruptures (3.7 % vs 2.8 %; P = .680) and sural nerve disturbances (4.5 % vs 2.8 %; P = .487) in the group of percutaneous repairs, with no statistically significant difference. Functional assessment using the American Orthopaedic Foot and Ankle Society scale and the Holz score showed no statistically significant difference. Conclusion: The results of the study support the choice of (modified) percutaneous suturing under local anesthesia as the method that brings comparable functional results to open repair, with a significantly lower rate of complications.