Orthopedics Today, February 2016
Andrew R. Hsu, MD
Acute midsubstance Achilles tendon ruptures, an increasingly common athletic injury in patients 30 years to 50 years old, can result in significant functional limitation and decreased quality of life. The management of these injuries is controversial, with no consensus in the literature regarding the use of surgical treatment or optimal repair technique.
The American Academy of Orthopaedic Surgeons clinical practice guidelines report moderate evidence that nonoperative treatment of Achilles tendon ruptures has lower wound healing complications, but higher rates of re-rupture. In addition, limited incision approaches have been found to have fewer overall complications compared with traditional open repair. A recent meta-analysis comparing open and limited incision Achilles repair techniques furthered this evidence, finding less invasive approaches have a significantly reduced risk of superficial wound infection and greater patient satisfaction compared with open repair. Taken together, these findings have helped stimulate the development of less invasive surgical techniques for acute Achilles tendon repair to optimize the functional benefits of surgery while reducing postoperative complications.