Comparison of Achilles Tendon Ruptures Treated with Open, Percutaneous, or Mini-Open Repair Techniques: A Meta-Analysis

Category: Trauma; Sports Introduction/Purpose: Achilles tendon ruptures is the most common tendon rupture in the lower extremity, causing pain and disability. This injury most commonly occurs in those who engage in physical activities, such as soccer and basketball. Historically the most common surgical technique that was used was the open repair technique, then followed the percutaneous repair technique, and even more recently the mini-open repair technique. Although there have been previous studies that looked at the differences between two of these techniques, there is no meta-analysis to compare all three surgical techniques. The primary purpose of this study was to compare the outcomes between the three surgical techniques for Achilles tendon rupture, which are open repair, percutaneous repair, and mini-open repair. Methods: We searched multiple databases, including PubMed, Google Scholar, and EMBASE, from the inception to November 2023. The eligibility for articles selected included being a comparative study between two of the surgical techniques and having included at least one outcome that was of interest in this study. Meta-analysis was processed by RevMan Web for the open versus percutaneous and open versus mini-open repair groups, and the continuous variables (AOFAS score, ATRS score, average operating time) in the percutaneous versus mini-open group. The Fisher test was used for the dichotomous variables in the percutaneous versus mini-open group due to the small sample sizes. A p-value of ≤ .05 was considered statistically significant. Results: 26 studies including a total of 1898 patients met the inclusion criteria. The percutaneous group had a significantly higher sural nerve injury rate (p < 0.001), lower infection rate (p = 0.006), higher AOFAS score (p = 0.03), higher ATRS score (p = 0.03), and shorter average operating time (p < 0.001) than the open group. In relation to the mini-open group, the percutaneous group had a significantly lower AOFAS score (p = 0.02), lower ATRS score (p = 0.001), shorter average operating time (p < 0.001), higher re-rupture rate (p = 0.03), and higher sural nerve injury rate (p = 0.05). The open group had significantly a higher infection rate (p = 0.04) than the mini-open group. Conclusion: Percutaneous repair had advantages in infection rate, AOFAS score, ATRS score, and average operating time compared to the open repair group. However, the mini-open repair seems to be the superior technique, having advantages in AOFAS score, ATRS score, re-rupture and sural nerve injury rates compared to the percutaneous repair and having a lower infection rate than open repair. In the future, more studies with larger sample sizes should be done to further determine which operative technique is most beneficial.