Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Surgical Techniques

Background:

• Traditional Achilles rupture repair uses a prone position with a large incision.
• Prone positioning can lead to longer operative times and potential complications like airway issues and nerve palsies.
• A mini-open supine approach offers an alternative to minimize these risks.

Purpose of the Study:

• To describe and evaluate a mini-open approach for acute Achilles rupture repair using supine patient positioning.
• To compare the outcomes and complications of this technique with the traditional prone approach.
• To present a reproducible technique with a single, small incision and no specialized equipment.

Main Methods:

• A 3-4 cm mini-open incision is made with the patient in the supine position.
• The Achilles tendon is repaired using a 4-stranded double Krackow locking stitch with FiberWires.
• Postoperative management includes splinting, controlled ankle motion (CAM) boot use, and progressive weight-bearing and physical therapy.

Main Results:

• The mini-open supine approach has a lower overall complication rate (7.7%) compared to the traditional prone approach (9.3%).
• No reruptures were observed in either cohort within the first year.
• This technique is associated with decreased operating room time, anesthesia burden, and costs.

Conclusions:

• The mini-open supine approach is a safe and effective technique for acute Achilles rupture repair.
• It offers comparable repair outcomes to traditional methods while reducing complications and costs.
• This technique is reproducible, requires no specialized instrumentation, and can be performed in any facility.