Minimally invasive surgery may be safe, reliable for acute Achilles tendon ruptures
Compared with open Achilles tendon repair, a minimally invasive approach to acute Achilles tendon ruptures resulted in shorter surgical times, lower risk of superficial infection and improved range of motion, according to published results.
Ahmed Khalil Attia, MD, and investigators at Emory University School of Medicine in Atlanta performed a systematic review and meta-analysis of 10 randomized controlled trials (RCTs), which compared 260 patients who underwent open surgery and 262 patients who underwent minimally invasive surgery (MIS) for acute Achilles tendon ruptures. According to the study, outcome measures included American Orthopaedic Foot & Ankle Society score, rerupture, sural nerve injury, infection, skin complications, adhesion, range of motion (ROM) and surgical time.
Mean postoperative AOFAS scores were 94.8 and 95.7 for the open and MIS cohorts, respectively. Investigators found no significant differences between the cohorts in total complication rate, rerupture rate, deep infection, skin necrosis, dehiscence rate, adhesion rate or keloid scar rate.
Investigators noted improved ROM in the MIS cohort. Mean surgical time was 51 minutes for the open cohort and 29.7 minutes for the MIS cohort. Additionally, mean overall superficial infection rate was 6% in the open cohort and 0.4% in the MIS cohort. However, mean sural nerve injury rate was 3.4% in the MIS cohort. No patients in the open cohort reported a sural nerve injury.
“We found MIS to be a safe and reliable technique. However, high-quality standardized RCTs are still needed before recommending MIS as the gold standard for managing Achilles tendon ruptures,” the investigators wrote in the study.