Utilizing A Percutaneous Versus Open Achilles Tendon Repair Technique for Treating Acute Achilles Tendon Ruptures in Physically Active Adults: A Critically Appraised Topic

in Journal of Sport Rehabilitation

Click name to view affiliation

Arhum SaleemHerbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

Search for other papers by Arhum Saleem in
Current site
Google Scholar
PubMed
Close
*
,
Irfan A. KhanHerbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

Search for other papers by Irfan A. Khan in
Current site
Google Scholar
PubMed
Close
,
Nisha J. CrouserWexner Medical Center, The Ohio State University, Columbus, OH, USA

Search for other papers by Nisha J. Crouser in
Current site
Google Scholar
PubMed
Close
, and
Kevin D. MartinWexner Medical Center, The Ohio State University, Columbus, OH, USA

Search for other papers by Kevin D. Martin in
Current site
Google Scholar
PubMed
Close
Restricted access

Clinical Scenario: Acute Achilles tendon ruptures can be devastating injuries with the potential to significantly alter an individual’s ability to perform functional activities. Given the rise in the incidence of acute Achilles tendon ruptures, it is important to determine whether percutaneous versus open Achilles tendon repair facilitates superior outcomes. Clinical Question: In physically active adults with an acute Achilles tendon rupture, does performing percutaneous Achilles tendon repair result in improved outcomes compared with open Achilles tendon repair? Summary of Key Findings: Percutaneous Achilles tendon repair has similar efficacy as open Achilles tendon repair in facilitating return to activity/sport, and demonstrates improvement in short-term functional outcomes with potentially lower wound complication rates. Clinical Bottom Line: Evidence supports the utilization of percutaneous Achilles tendon repair in physically active adult patients with acute Achilles tendon ruptures. It is important to critically review the benefits, risks, and alternatives of each treatment option based on patient characteristics. In addition, postoperative expectations should be discussed with the patient to set appropriate goals for recovery and improve overall satisfaction. Strength of Recommendation: A grade B recommendation can be made based on “fair” to “good” evidence from 2 level 2b studies and 1 Level 1b study to support the utilization of percutaneous Achilles tendon repair techniques.

Saleem (Asale046@med.fiu.edu) is corresponding author.

  • Collapse
  • Expand
  • 1.

    Park SH, Lee HS, Young KW, Seo SG. Treatment of acute Achilles tendon rupture. Clin Orthop Surg. 2020;12(1):18. doi:10.4055/cios.2020.12.1.1

  • 2.

    Raikin SM, Garras DN, Krapchev PV. Achilles tendon injuries in a United States population. Foot Ankle Int. 2013;34(4):475480. PubMed ID: 23386750. doi:10.1177/1071100713477621

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010(9):CD003674. PubMed ID: 20824836 doi:10.1002/14651858.CD003674.pub4

    • Search Google Scholar
    • Export Citation
  • 4.

    Henríquez H, Muñoz R, Carcuro G, Bastías C. Is percu-taneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res. 2012;470(4):9981003. doi:10.1007/s11999-011-1830-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Van Lieshout EM, De Boer AS, Meuffels DE, et al. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version. BMJ Open. 2017;7(2):e012884. doi:10.1136/bmjopen-2016-012884

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Nilsson-Helander K, Thomeé R, Grävare-Silbernagel K, et al. The Achilles Tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2007;35(3):421426. doi:10.1177/0363546506294856

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Cashin AG, McAuley JH. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. J Physiother. 2020;66(1):59. doi:10.1016/j.jphys.2019.08.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Oxford Centre for Evidence-Based Medicine. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence

    • Search Google Scholar
    • Export Citation
  • 9.

    Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB. Clinical outcomes and complications of percutaneous Achilles repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int. 2015;36(11):12791286. doi:10.1177/1071100715589632

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Rozis M, Benetos IS, Karampinas P, Polyzois V, Vlamis J, Pneumaticos SG. Outcome of percutaneous fixation of acute Achilles tendon ruptures. Foot Ankle Int. 2018;39(6):689693. doi:10.1177/1071100718757971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Saxena A, Maffulli N, Jin A, Isa E, Arthur WP, Asthana S. Acute Achilles tendon rupture repair in athletically active patients: results on 188 tendons. J Foot Ankle Surg. 2021;60(5):935940. doi:10.1053/j.jfas.2021.01.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res. 1977(128):247255. PubMed ID: 340096

    • Search Google Scholar
    • Export Citation
  • 13.

    Batra A, O’Sullivan J, Nicholson D, Rao P. Post-operative outcome of Achilles tendon injury treated with knotless percutaneous Achilles repair system. Clin Res Foot Ankle. 2018;6(1):263. doi:10.4172/2329-910X.1000263

    • Search Google Scholar
    • Export Citation
  • 14.

    McGee R, Watson T, Eudy A, et al. Anatomic relationship of the sural nerve when performing Achilles tendon repair using the percutaneous Achilles repair system, a cadaveric study. Foot Ankle Surg. 2021;27(4):427431. doi:10.1016/j.fas.2020.05.011

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1524 1075 22
Full Text Views 270 264 0
PDF Downloads 127 118 0