Comparison the Early and Mid-term Clinical outcomes between Percutaneous Surgery and Open Surgery for Acute Achilles Tendon Rupture

Objective : We developed a self-designed percutaneous repair technique which does not require specialized suturing instruments and minimize the risk of sural nerve injury and incision complications. In this retrospective study,we compare the early and mid-term clinical outcomes of two surgical procedures: a self-designed percutaneous repair technique and open repair surgery for AATR. Methods : A retrospective analysis was conducted on 48 cases of closed AATR treated between March 2020 and February 2022. 26 cases were treated with the self-designed percutaneous repair technique, while 22 cases accepted open surgery. There were no statistically significant differences in age, gender, side of AATR, and the distance to the tendon insertion point between the two groups. All patients were followed up for no less than 12 months. The surgical duration, the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score and the Achilles Tendon Total Rupture Score (ATRS) at 3, 6, and 12 months postoperatively were compared between the two groups. Results : The patients' age ranged from 19 to 47 years (mean 32.2) and all were followed up for an average of 18.2 months (range 12–26). One case experienced a superficial incision infection which resolved with dressing changes for 3 weeks, and two cases exhibited scar tissue adhesions in the open surgery group, while one case of scar tissue adhesion was present in the percutaneous group. There were no cases of tendon re-rupture and sural nerve injury in the follow-up. The percutaneous group had a shorter surgical duration compared to the open surgery group (33.5±4.6 min vs 51.1±3.7 min, P<0.05). At 3 months postoperatively, the percutaneous group showed superior AOFAS (81.9±2.3 vs 76.9±3.8, P<0.05) and ATRS (82.0±2.3 vs 77.2±4.0, P<0.05) compared to the open surgery group. At 6 months postoperatively, the percutaneous group exhibited higher AOFAS (91.6±2.5 vs 89.3±3.1, P<0.05) and comparable ATRS (92.4±2.6 vs 90.7±3.2, P>0.05) than the open surgery group. At 12 months postoperatively, there were no statistically significant differences in AOFAS (97.4±1.5 vs 97.2±2.4, P>0.05) and ATRS (97.5±1.6 vs 97.6±2.7, P>0.05) between the two groups. The incidence of complications in the percutaneous group (3.8%) was lower than the open surgery group (13.6%), but there was no statistically significant difference between the two groups(P=0.485). Conclusions : The self-designed percutaneous repair technique offers a shorter surgical duration and faster postoperative recovery compared to open surgery for AATR, while there was no significant difference in mid-term clinical outcomes and postoperative complications.