Endoscopic Assistance in Minimally Invasive Repair of Acute Achilles Ruptures: A Prospective Observational Study...

Area of Science:

• Orthopedics
• Sports Medicine
• Surgical Innovation

Background:

• Optimal management for acute Achilles tendon (AT) ruptures is debated, with surgery historically favored over conservative treatment to prevent rerupture.
• Minimally invasive (MIS) and percutaneous techniques have emerged to reduce complications associated with traditional open surgery, though they may increase sural nerve palsy risk.
• Endoscopic assistance aims to enhance visualization during MIS for AT repair, potentially lowering complication rates, but its benefits require further validation.

Purpose of the Study:

• To compare the clinical outcomes and functional recovery of three surgical techniques for acute Achilles tendon ruptures: endoscopic-assisted MIS, Ma-Griffith minimally invasive technique (M-G/MISI), and traditional open surgery.
• To evaluate the impact of each surgical approach on return to driving (RTD), return to work (RTW), and return to sports (RTS).
• To assess patient-reported outcomes using the Achilles tendon Total Rupture Score (ATRS) and Ankle Hindfoot American Orthopaedic Foot and Ankle Society (AH-AOFAS) scores.

Main Methods:

• A prospective observational study involving 94 patients undergoing surgical repair for acute subcutaneous AT rupture.
• Patients were divided into three groups: endoscopic-assisted MIS (n=30), M-G/MISI (n=34), and traditional open surgery (n=32).
• Functional recovery was assessed by RTD, RTW, and RTS. Clinical outcomes were measured using ATRS and AH-AOFAS scores, with a mean follow-up of 32 months.

Main Results:

• Significant differences were observed in RTD (p=0.001), RTW (p<0.001), and ATRS (p<0.001) among the groups.
• The M-G/MISI group demonstrated a faster return to driving and work, along with higher ATRS scores, compared to the open surgery group (p<0.05).
• No significant differences in clinical outcomes or sural nerve safety were found between the M-G/MISI and endoscopic-assisted techniques. RTS and AH-AOFAS scores did not differ significantly across groups.

Conclusions:

• All three surgical techniques for acute Achilles tendon ruptures yield good functional outcomes and low complication rates.
• While endoscopic assistance aids visualization, it did not demonstrate superiority in clinical outcomes or sural nerve safety compared to M-G/MISI.
• The Ma-Griffith minimally invasive technique (M-G/MISI) is associated with faster return to activity and improved patient-reported outcomes (ATRS) compared to traditional open repair.