A clinical comparison of two different surgical techniques in the treatment of acute Achilles tendon ruptures: Limited-open approach vs. percutaneous approach

BACKGROUND: Surgical treatment is the commonly preferred method for treating acute Achilles tendon ruptures (AATRs) due to advantages such as less re-rupture rates, better functional results, and an early return to physical activities. The main aim of our study is to compare two common minimally invasive surgical methods, the limited open and the percutaneous approaches, regarding clinical outcomes. METHODS: A total of 53 patients (19 females and 34 males) who were treated with limited open (Group 1: 30 patients) and percutaneous (Group 2: 23 patients) approaches for AATRs were retrospectively evaluated between March 2019 and May 2020 in a level 1 trauma center. The evaluation included complications (soft tissue and skin problems, re-rupture, and sural nerve injury rates), the operation time, the duration of return to daily activities, The Achilles Tendon Total Rupture Score (ATRS), and the American Orthopedic Foot and Ankle Society (AOFAS) scores of the patients at the first and 6(th) months of follow-up. Patients’ activity levels were compared with the Tegner Activity Scale (TAS). RESULTS: The mean age of all patients in this cohort was 45.1±14.1. The mean postoperative follow-up period for group 1 was 36.9±8.81 weeks, whereas, for group 2, it was 35.4±8.73 weeks (P=0.24). The mean age (P=0.47), gender distribution (P=0.41), and body mass index (P=0.29) were similar for both groups. The mean operation time (group 1: 47.1±5.4 vs. group 2: 44.4±6.1, P=0.06) and the duration of return to daily activities (group 1: 49.2±7.4 vs. group 2: 48.5±9.7, P=0.38) were also similar. There was no statistical difference between groups regarding functional results at first (ATRS: group 1: 79.9±3.2 vs. group 2: 79.5±3.9, [P=0.35], and AOFAS: group 1: 80.9±3.1 vs. group 2: 82.1±3.2, [P=0.10]) and 6(th) months (ATRS: group 1: 85.0±3.8 vs. group 2: 83.7±4.4, [P=0.13], and AOFAS: group 1: 86.6±3.6 vs. group 2: 86.7±4.2, [P=0.46]). There were no statistically significant differences between groups regarding preoperative and last follow-up TAS scores (P=0.94 and P=0.46, respectively). We observed no postoperative complications in group 1. There were three complications (13.1%) in group 2. One patient (4.4%) had a re-rupture, and two patients (8.7%) had sural nerve injuries. CONCLUSION: Although both groups had similar functional results, the limited open approach yielded better clinical outcomes according to the complication results than the percutaneous approach.