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Results of Achilles Insertional Repair Techniques: Minimally Invasive Compared to Open Repair
Jorge I Acevedo1, Sofia Rivera1, Kelsey A Crawford1,2
1Southeast Orthopedic Specialists, Jacksonville, FL, USA.
Background:
Insertional Achilles tendinopathy (IAT) is a common yet challenging condition that often resists conservative treatment. Traditional open surgical repair carries risk of complications including delayed wound healing and infection. This study compares the outcomes of a minimally invasive surgical (MIS) technique using arthroscopic-assisted double-row repair vs open repair.
Methods:
Fifty-six patients with IAT underwent surgical intervention between June 2021 and September 2024 (32 MIS, 24 open). Patient-reported outcomes (PROs) were assessed pre- and post-operatively with a minimum 1-year follow-up. Six patients were excluded from analysis for comparability between groups. Statistical analysis used 2-tailed t tests with a Bonferroni adjustment (α = 0.05/3 = 0.0167). The proportion of each cohort reaching the minimal clinically important difference (MCID) was compared via χ2 analysis, and complications were correlated to body mass index (BMI) and age using logistic regression analyses. Sensitivity analyses using multiple linear regressions, adjusted for follow-up time, were performed on the full cohort (α = 0.05).
Results:
The MIS group had significantly worse preoperative scores compared with the open group. But at a mean follow-up of 2.2 years for the MIS group and 2.0 years for the open group, the MIS group demonstrated significantly greater improvements in Patient-Reported Outcomes Measurement Information System physical function and visual analog scale scores (P < .001 for both) and a significantly greater proportion of patients at MCID (P < .05 for both). Foot and Ankle Ability Measure activities of daily living subscale showed similar findings without significance detected. All PROs retained significance on sensitivity analysis. Complication rates were 0% in the MIS group and 5.0% in the open group with no correlation to BMI or age.
Conclusion:
Despite limitations necessitating further studies, our results begin to suggest superior functional outcomes following MIS repair for IAT compared to traditional open repair, supporting MIS as a potentially safer and more effective alternative for appropriate patients.
Level Of Evidence:
Level III, retrospective comparative study.
