Timing of Achilles Tendon Revision within 2 Months of Primary Repair Affects Incidence of Acute Complications

Early revision of primary Achilles tendon repair is sometimes necessary, and the Achilles tendon's inherent hypovascularity creates a uniquely challenging biological environment for reoperation. However, the optimal timing for revision and its associated complication risks remain poorly characterized.

To evaluate the relationship between the timing of early Achilles tendon revision, performed within 8 weeks of primary repair, and the incidence of acute postoperative complications.

Using the PearlDiver M91Ortho data set, patients who underwent Achilles tendon revision 0 to 8 weeks after primary Achilles tendon repair and did not have a diagnosis of diabetes mellitus were stratified into groups based on the interval between operations: 0 to 2 weeks, 2 to 4 weeks, 4 to 6 weeks, and 6 to 8 weeks. The rates of complications, including deep vein thrombosis, pulmonary embolism, superficial and deep surgical-site infection (SSI), wound dehiscence, debridement, and complex regional pain syndrome, were identified. Complication rates across timing groups were compared using chi-square tests and Fisher's exact tests with Bonferroni correction for pairwise analyses.

Among 759 patients, sex and age distributions did not differ significantly across timing groups. Overall complication rates varied significantly by revision interval, as did wound dehiscence and deep SSI. Superficial SSI occurred only in the 2-to 4-week group. The post hoc testing showed significantly higher overall complication rates for the 2- to 4-week and 4- to 6-week groups compared with the 0- to 2-week and 6- to 8-week groups. Wound dehiscence was more frequent in the 2- to 4-week and 4- to 6-week groups compared with the 0- to 2-week group. Deep SSI occurred more often in the 2- to 4-week and 4- to 6-week groups compared with the 6- to 8-week groupConclusion:Revision occurring at 2-6 weeks after primary Achilles tendon repair is associated with a significantly higher risk of complications compared with revisions within 0-2 weeks or at 6-8 weeks, thereby suggesting an optimal revision-timing window to mitigate adverse outcomes.

Retrospective cohort study (Level of Evidence III).