Patient-Centered Outcomes After Minimally Invasive Internal Splinting Versus Open Achilles Tendon Repair: Comparable...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Traditional comparative studies on Achilles tendon rupture repair often use mean-based statistics, potentially overlooking patient-perceived clinical significance.
• Minimally invasive surgery (MIS) and open repair are common treatments for acute Achilles tendon ruptures, but patient-centered outcome comparisons are limited.

Purpose of the Study:

• To compare 12-month patient-centered outcomes between MIS (internal splinting) and open repair for acute Achilles tendon ruptures.
• To establish anchor-based minimal clinically important difference (MCID) thresholds for key outcome measures.
• To compare patient-centered responder outcomes, including MCID achievement and Patient Acceptable Symptom State (PASS), between the two surgical techniques.

Main Methods:

• Retrospective comparative cohort study of 70 patients (35 MIS, 35 open repair) undergoing surgical repair for acute Achilles tendon rupture.
• Outcome assessments included Visual Analog Scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) score, Achilles Tendon Rupture Score (ATRS), and Thermann score.
• Anchor-based MCID thresholds were determined using Receiver Operating Characteristic (ROC) curve analysis with the Global Rating of Change (GROC) scale; Patient Acceptable Symptom State (PASS) was also assessed.

Main Results:

• Both MIS and open repair groups showed significant improvements in all outcome measures at 12 months (p < 0.001).
• No significant differences were found between groups in mean functional scores, MCID achievement rates, PASS rates, or GROC-defined clinical success (p > 0.05).
• Exploratory MCID thresholds were identified: VAS reduction > 4.8, AOFAS/ATRS increase > 38, and Thermann score increase > 37. MCID achievement for functional outcomes was 62.9% for MIS and 57.1% for open repair.

Conclusions:

• Both minimally invasive surgery and open repair techniques result in substantial and clinically meaningful recovery at 12 months for Achilles tendon ruptures.
• Neither surgical approach demonstrated a significant advantage in patient-centered outcomes, including pain, function, or overall satisfaction.
• Established MCID thresholds may serve as benchmarks for future research, but surgical decisions should prioritize surgeon expertise and patient-specific factors over technique-driven outcome expectations.