Regional Technique for Achilles Tendon Repair
For Achilles tendon repair, percutaneous or minimally invasive techniques are recommended as they provide better outcomes with fewer complications compared to open repair. 1, 2
Comparison of Surgical Techniques
Percutaneous Repair
- Percutaneous repair techniques show better outcomes with higher Achilles Tendon Rupture Score (ATRS) at long-term follow-up (92.5 vs 82 for open repair) 1
- Percutaneous techniques like the Percutaneous Achilles Repair System (PARS) allow patients to return to baseline physical activities by 5 months 2
- Patients treated with percutaneous repair scored significantly higher on physical and mental component scores compared to open repair 3
- Percutaneous repair results in significantly less wound breakdown/delay of healing and fewer scar adhesions 3
Minimally Invasive Repair
- Minimally invasive techniques limit wound and soft-tissue complications such as infections 2
- Minimally invasive approaches protect neurovascular structures like the sural nerve that may be injured with other techniques 2
- Limited open repair allows patients to return to normal walking, stair climbing, and sports in significantly less time than standard open repair 3
- Patients treated with limited open repair had significantly fewer severe wound infections and superficial infections compared to open repair 3
Open Repair
- Open repair demonstrates significantly less elongation (5.2 ± 1.1 mm) compared to minimally invasive percutaneous repair methods (9.9-12.2 mm) during rehabilitation 4
- Open repair may allow for earlier and/or more aggressive postoperative rehabilitation with lower risk of early repair elongation 4
- However, open repair has higher rates of wound complications and infection 3, 5
Post-Operative Management
Early Weight Bearing
- Early protected weight bearing (≤2 weeks) is recommended following Achilles tendon repair 6
- Early weight bearing allows quicker return to activities during the first 6 months compared to traditional non-weight bearing protocols 3, 6
- The walking boot must limit dorsiflexion to protect the tendon during the healing process 6
Rehabilitation Protocol
- Begin mobilization by 2-4 weeks using a protective device 7, 6
- Transition to a protective device that limits dorsiflexion after initial immobilization period 7
- By 12 months, outcomes such as pain and function are similar regardless of early or delayed weight bearing protocols 6
Important Considerations
Complications to Monitor
- Sural nerve injuries can occur with both percutaneous and open techniques 3
- Deep vein thrombosis is a potential complication that requires monitoring 7
- Wound puckering occurs significantly more in patients treated with percutaneous repair 3
- Minimally invasive percutaneous repairs may be susceptible to significant early repair elongation compared to open repairs 4
Patient Selection Factors
- For high-level athletes and those with delayed presentation, surgical repair is preferred over non-surgical management 5
- Younger patients hoping to return to competitive athletics should consider operative repair 5
- Patient compliance with the prescribed protocol is crucial to prevent rerupture 6
Conclusion
Percutaneous or minimally invasive techniques provide the best balance of outcomes and complications for Achilles tendon repair. These approaches result in better functional scores, fewer wound complications, and faster return to activities while maintaining similar strength to open repair techniques.