Patient Reported Outcomes of Minimally Invasive Achilles Rupture Repair

Category: Other; Sports Introduction/Purpose: The optimal surgical management of Achilles ruptures remains controversial. The Percutaneous Achilles Repair System (PARS) (Arthrex Inc; Naples, FL) utilizes knots to secure tension at the rupture site. The more recently developed Midsubstance Speedbridge Implant System (MSB) (Arthrex Inc; Naples, FL) utilizes interference screws to tension the repair. Prior studies have compared patient reported outcomes (PROs) utilizing the Patient Reported Outcomes Information System (PROMIS) computerized adaptive tests of physical function (PF) and pain interference (PI) and the Achilles Tendon Total Rupture Score (ATRS) between open and minimally invasive repair techniques. No study has compared PF, PI, and ATRS PROs between PARS and MSB techniques. We hypothesized that PROs would be similar between patients who underwent MSB repair and patients who underwent PARS repair. Methods: All 434 patients who underwent Achilles rupture repair between January 1st, 2018 and January 1st, 2023 at our institution were emailed a weblink via REDCap to complete the PROMIS PF and PI and the ATRS questionnaire measures. Excluded surgical indications were tendinopathies, open injuries, or concomitant fractures. Open repairs, tendon transfers, or gastrocnemius recessions were also excluded. A total of 119 included patients completed all surveys. Groups were defined as those who underwent repair with PARS technique (n=78) and those who underwent MSB technique (n=41). The Mann-Whitney U test assessed differences in distribution of PF, PI, and ATRS scores between groups. Between groups, we compared postoperative complications using the Fischer exact test and months to return to preinjury level of activity using the Student’s t-test for independent samples. Results: There was no significant difference in PF, PI, and ATRS measures between PARS and MSB (P > .05). Mean PARS group PF, PI, and ATRS scores were 58.77, 44.21, and 85.99, respectively. Mean MSB group PF, PI, and ATRS scores were 55.26, 44.01, and 82.51, respectively. Mean months to return to preinjury level of activity was 9.28 for PARS and 9.4 for MSB (P = 0.96). Each postoperative complication had no significant difference of incidence between groups (P > .05). The rates of complications for PARS and MSB, respectively, were 0.9% (2/212) and 0% deep vein thrombosis, 1.9% (4/212) and 0% rerupture, 1.9% (4/212) and 1.0% (1/104) sural nerve injury, 4.2% (9/212) and 2.9% (3/104) wound complication, and 2.8% (6/212) and 2.9% (3/104) reoperation. Conclusion: This is the largest study to compare patient reported outcomes between PARS and MSB minimally invasive Achilles tendon rupture repairs. Both techniques achieve physical function patient reported outcomes that are greater than the population mean and pain interference that is lower than the population mean. Each technique has low rates of postoperative complications and similar ATRS scores. Overall, the MSB and PARS minimally invasive Achilles repair techniques are safe and effective strategies for surgically managing Achilles ruptures.