Review Question - QID 216304

Open repair of a ruptured Achilles tendon is associated with a higher complication rate than percutaneous repair.

Trials directly comparing open versus percutaneous techniques of Achilles repair have failed to show a difference in functional outcome or re-rupture rate. However, minimally invasive techniques have resulted in lower rates of minor complications such as superficial wound infection and decreased local scarring at the incision site. There have been increased rates of sural nerve injuries reported with percutaneous techniques compared to open procedures. This is due to direct identification and protection of the nerve with open repairs.

Aktas et al. prospectively compared 40 patients treated surgically for acute Achilles tendon rupture. Half were treated with Krakow end-to-end suturing, half were treated percutaneously. They found that functional outcomes were equal, but the percutaneous group had more favorable rates of local skin tenderness, scar adhesions, scar thickness, and tendon thickness.

Gigante et al. randomized 40 consecutive patients with acute Achilles rupture to receive either open or percutaneous repair. They found two minor complications (delayed wound healing) in the open group and one failed repair in the percutaneous group. They concluded that both techniques produced equal results, but that the percutaneous technique was favored due to decreased surgical time and fewer cutaneous complications.

Incorrect answers:
Answer 1: Percutaneous repair techniques for Achilles tendon ruptures have been associated with increased sural nerve injuries compared to traditional open techniques.
Answer 2 and 3: No statistically significant difference in rates of calf circumference or re-rupture has been demonstrated when comparing open and percutaneous techniques of Achilles repair.
Answer 5. The percutaneous techniques have been shown to result in decreased local scarring compared to open procedures.