Outcomes of the Mini-Open Technique for Achilles Tendon Repair: An Updated Systematic Review

There is much debate regarding the optimal treatment for acute Achilles tendon rupture. Surgical repair consists of open repair, percutaneous repair, and mini-open repair. The purpose of this review is to evaluate studies reporting outcomes after mini-open Achilles tendon repair (ATR) through evaluation of return to activity (RTA), complication rates, and postoperative patient-reported outcomes (PROs). A systematic review search following the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed in three databases for studies including mini-open ATR. Study variables included title, author, publication date, study year, number of patients/Achilles, mean age, mean follow-up time, time to RTA/return to sport (RTS)/return to work (RTW), PROs, and rates of complications. Twenty-five studies, including 957 patients with a mean age of 39.34 ± 6.84 years and a mean follow-up time of 29.48 ± 17.64 months, were included in this study. The overall rates (range) of RTA (eight studies), RTS (12 studies), and RTW (eight studies) were 96.46% (82.3%-100%) at four months (3.8-7), 92.7% (82.3%-100%) at 5.4 months (4.3-6.1), and 100% at 2.2 months (0.6-4.5), respectively. The mean postoperative PROs of the American Orthopedic Foot and Ankle Score (11 studies), Achilles Tendon Total Rupture Score (eight studies), and Visual Analog Pain (four studies) were 95.5 (90.1-99.2), 90.3 (86-94.6), and 3.35 (0.2-8.85), respectively. The overall complication rate for mini-open repair was 8.05%, with the most common being sural nerve injury, rerupture, and skin adhesions. The mean rates of sural nerve injury and rerupture were 1.67% and 1.25%. Patients undergoing mini-open ATR demonstrated high rates of return to baseline activity, low rates of complications, and excellent postoperative PRO scores. Mini-open repair is a reliable technique with comparable functional outcomes to traditional open repair, with lower rates of infections and wound healing issues.