Okan Yigit, Meltem Karacaatli Erdogan, Sebati Baser Canbaz, Emrah Gokay Ozgur, Ogulcan Unsalan, Servet Igrek, Engin Eceviz
Acta Orthopaedica et Traumatologica Turcica - 2025;59(6):394-404
Objective: While surgical repair is standard for acute Achilles tendon ruptures, the optimal technique remains debated. This study compares clinical, functional, and ultrasonographic outcomes between minimally invasive and open surgical approaches, with particular focus on: (1) patient-reported recovery, (2) tendon healing dynamics, and (3) the utility of ultrasound in postoperative monitoring. Methods: This retrospective study analyzed 108 consecutive patients undergoing surgical repair for acute Achilles tendon ruptures between 2015-2023, comparing minimally invasive (n = 58; ring forceps technique) and open approaches (n = 50; Krackow technique). Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS), Patient-Reported Outcomes Measurement Information System (PROMIS), and Madrid Sonographic Enthesitis Index (MASEI) scores at standardized 6-, 12-, and 24-month follow-ups, while ultrasonographic evaluations quantified tendon thickness at rupture and insertion sites relative to contralateral tendons. Complication rates and demographic variables were systematically reviewed, with all patients receiving identical postoperative rehabilitation protocols. Results: A total of 108 patients were included in the study, with a mean age of 41.56 +/- 13.98 years (range, 18-68). Minimally invasive surgery was performed in 58 patients (53.7%), while the remaining 50 patients (46.3%) underwent open surgical repair. The mean follow-up duration was 2.4 years (minimum of 2 years of follow-up). Patients in the minimally invasive group reported significantly higher PROMIS scores compared to those in the open surgery group (P < .001). However, no significant differences were observed in AOFAS or MASEI scores between the groups (P > .05). Ultrasonographic evaluation revealed that the mean tendon thickness at the rupture site was significantly greater in the minimally invasive group (1.04 cm; range, 0.93-1.15) than in the open surgery group (0.87 cm; range, 0.77-0.93) (P < .001). Furthermore, the operated-to-intact tendon thickness ratio was 2.13 in the minimally invasive group and 1.78 in the open surgery group, which was also statistically significantly different (P = .006). Conclusion: Minimally invasive Achilles tendon repair was associated with potential advantages compared to open techniques, including more favorable patient-reported outcomes (median PROMIS score 80 vs. 76, P < .001), increased tendon thickness (19% greater, P < .001), a potential indicator of differential healing patterns, and lower wound complication rates, while importantly achieving equivalent high-level function as measured by the AOFAS and MASEI scores.
