Percutaneous versus Open Achilles Tendon Repair: A Case-Control Study

Abstract

Purpose: We investigated whether percutaneous suturing of Achilles tendon ruptures showed better results and superiority in terms of clinical outcomes when compared to open suturing. Methods: We conducted a case-control study. Between 2009 and 2014, we performed surgical revisions of closed acute Achilles tendon ruptures in our hospital in 146 patients, of which 71 patients (2012-2014) received percutaneous suturing using Dresden instruments, and 75 patients (2009-2012) underwent open suturing. After a minimum period of 1 year post surgery, we performed clinical follow-up in 25 patients of each of the groups using the AOFAS hind foot score and the SF-12 questionnaire. Furthermore, we implemented a clinical questionnaire with a reference population of 200 healthy individuals. Results: Mean age in the total population of 146 patients was 47 years (range 21 to 83 years) at the time of surgery. The duration of the surgical procedure with percutaneous suturing was significantly shorter (24 versus 43 minutes, p < 0.0001), the complication rate was significantly lower (2.81% versus 10.7%, p < 0.0001), and the time of hospitalisation was significantly shorter (3 versus 4 days, p < 0.0001) when compared to open suturing. During f ollow-up, no significant differences between the two groups were observe d in terms of descriptive parameters. Furthermore, ultrasound examinations of both follow-up populations did not show any significant difference. From a clinical perspective, the good to very good results achieved with open suturing (as measured with the AOFAS hind foot score and the SF-12 ques tionnaire) have not been significantly improved with percutaneous suturing. The additional use of a new clinical score (with the reference population) demonstrated good to very good consistency with the established scores. Conclusion: In our population, percutaneous Achilles tendon suturing showed significantly lower complication rates and significantly shorter procedure times when compared to open suturing. However, percutaneous suturing did not show clinical improvements of the good to very good results that were achieved with open suturing (as measured with the AOFAS back foot score and the SF-12 questionnaire). The implementation of a new and simple score for the clinical evaluation of Achilles tendon injuries resulted in good to very good consistency with the established questionnaires and, thus, offered a straightforward and rapid alternative when compared to the more elaborate scores.