Comparison of Postoperative Complications by Surgical Technique After Acute Midsubstance Achilles Tendon Repair

Midsubtance Achilles tendon ruptures remain the most common tendon injury within the lower extremity. While the incidence continues to rise, changing immobilization protocols, surgical techniques, and surgeon preferences have evolved over the past few decades.

To compare the overall complication rate among 3 major surgical techniques (open, percutaneous, and suture anchor) across a large, heterogeneous orthopaedic group in a major metropolitan area.

Case series; Level of evidence, 4.

Achilles tendon repairs (Current Procedural Terminology code 27650) performed from January 2018 through December 2022 with a minimum 2-month follow-up were identified and retrospectively reviewed. Patients were excluded if they had chronic tears that required reconstruction, underwent a revision repair/reconstruction, or were initially treated nonoperatively. A total of 1035 acute midsubstance Achilles tendon ruptures met inclusion criteria. The primary outcome measure was total complication rate, which consisted of major complications (reoperation, deep infection, tendon rerupture, and loss of Achilles tension requiring reoperation) and minor complications (sural neuritis, superficial infection, delayed wound healing, heel pain, painful repair site, and loss of Achilles tension not requiring reoperation). Total, major, and minor complication rates by surgical technique were recorded. Standard demographic data were noted. Descriptive statistics and multivariate regression were utilized.

The overall complication rate was 15.7%, with 3% (n = 31) having major complications. Patients were significantly more likely to encounter any complication (26.3% complication rate with suture anchor, 14.3% with percutaneous, and 14.4% with open) (P = .004) or minor complication (P = .0304) with suture anchor fixation (20.2% rate) compared with the percutaneous (10.8%) or open (12.3%) technique. Patients with suture anchor fixation were more likely to experience clinically significant heel pain (10.5%; P < .001). There was no difference between incidence of sural neuritis with open (1.4%), percutaneous (3.2%), and suture anchor fixation (0.9%) (P = .104).

Acute Achilles tendon repair is associated with a major complication rate of 3% requiring reoperation. Patients undergoing suture anchor fixation of Achilles tendon injuries experience all complications and minor complications at a significantly higher rate than those undergoing percutaneous or open procedures.