Open versus percutaneous repair of acute Achilles tendon rupture: a systematic review

Background
The Achilles tendon is the strongest in the human body. It is most frequently ruptured in the third and fourth decade of age. Most studies have reported that usually ruptures during sports practice.
Objective
To compare open repair (OR) versus percutaneous repair (PR) for treating acute Achilles tendon rupture in a systematic review and evaluate the functional outcomes of each method.
Patients and methods
This systematic review is based on six articles selected from 5507 studies using PubMed, Google Scholar, and Cochrane Library. Articles included showed 329 patients with acute Achilles tendon ruptures. There were 165 patients who had an open surgical repair and 164 patients who had a PR with a mean follow-up of 23 months (range, 20–24 months). Variables of each article were recorded and analyzed with respect to age, sex, follow-up, complications, and final outcomes.
Results
The study revealed that there was a statistically significant difference between both groups regarding operative time to be faster in PR but regarding return to work it was faster in OR. Also, there was statistical significance difference regarding American Foot and Ankle Outcome Score to be higher for OR. Both groups did not significantly differ in re-rupture rate, infection, Achilles tendon Total Rupture Score and wound complications.
Conclusion
OR is a more traditional approach that involves making a larger incision to access the tendon. This allows the surgeon to have a more direct visualization of the tendon and to place the sutures more precisely. However, OR also carries a higher risk of complications, such as wound infection. PR is a newfound method with fewer complications and a better cosmetic appearance.