Complications of Minimally Invasive Achilles Repair Using the Midsubstance Speedbridge and Percutaneous Achilles Repair System

Category: Other; Sports Introduction/Purpose: Surgical management of Achilles ruptures with minimally invasive techniques reduces soft tissue injury and complication rates compared to open repair. No consensus in current literature identifies the optimal minimally invasive Achilles rupture repair technique to reduce complication rates. The Percutaneous Achilles Repair System (PARS) (Arthrex Inc; Naples, FL) utilizes knots to secure tension at the site of rupture. The more recently developed Midsubstance Speedbridge Implant System (MSB) (Arthrex Inc; Naples, FL) utilizes interference screws to tension the repair. Our institution performs a high volume of Achilles repairs by these two techniques. We hypothesized that complication rates and risk of complications would be similar between patients who underwent MSB repair technique and patients who underwent PARS repair technique. Methods: We retrospectively reviewed all 434 patients who underwent Achilles rupture repair between January 1st, 2018 and January 1st, 2023 at our institution. Patients were excluded if surgical indications included tendinopathies, open injuries, or concomitant fractures, or if their operation included tendon transfers, gastrocnemius recessions, or open repairs. Groups identified for inclusion were defined as those who underwent PARS technique (n=212) and those who underwent MSB technique (n=104). The Fisher exact test was used to compare incidence of heel pain at last visit and incidence of complications including deep vein thrombosis (DVT), pulmonary embolism (PE), sural nerve injury, rerupture, and reoperation between PARS and MSB techniques. We combined the listed complications to create a discrete variable indicating whether a patient experienced any one complication. Using logistic regression with a log-link, we evaluated the relative risk of experiencing any one complication between PARS and MSB techniques. Results: There was a significantly lower relative risk of experiencing any one complication in the MSB group compared to the PARS group (RR=0.31, 95% CI 0.11-0.88). There was no significant difference of incidence of each complication between groups. The rates of complications in the MSB group were 0% deep vein thrombosis (DVT), 0% rerupture, 1.0% (1/104) sural nerve injury, 2.9% (3/104) wound complication, and 2.9% (3/104) reoperation. The rates of complications in the PARS group were 0.9% (2/212) DVT, 1.9% (4/212) rerupture, 1.9% (4/212) sural nerve injury, 4.2% (9/212) wound complication, and 2.8% (6/212) reoperation. MSB demonstrated a significantly higher incidence of heel pain at last follow-up (P=0.01). Males experienced a lower relative risk of complication compared to females (RR=0.39, 95% CI 0.17-0.90). Conclusion: The MSB and PARS minimally invasive Achilles repair techniques are safe and effective at surgically managing Achilles ruptures. In the largest known study to compare PARS and MSB repair technique complications, we found that the MSB technique reduces the overall risk of a complication from minimally invasive Achilles rupture repairs.