Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 998–1003 | Cite as

Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?

  • Hugo HenríquezEmail author
  • Roberto Muñoz
  • Giovanni Carcuro
  • Christian Bastías
Symposium: Arthroscopy



Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair.


We compared the two types of repairs in terms of (1) function (muscle strength, ankle ROM, calf and ankle perimeter, single heel rise tests, and work return), (2) cosmesis (length scar, cosmetic appearance), and (3) complications.

Patients and Methods

We retrospectively reviewed 32 surgically treated patients with Achilles rupture: 17 with percutaneous repair and 15 with open repair. All patients followed a standardized rehabilitation protocol. The minimum followup was 6 months (mean, 18 months; range, 6–48 months).


We observed similar values of plantar flexor strength, ROM, calf and ankle perimeter, and single heel raising test between the groups. Mean time to return to work was longer for patients who had open versus percutaneous repair (5.6 months versus 2.8 months). Mean scar length was greater in the open repair group (9.5 cm versus 2.9 cm). Cosmetic appearance was better in the percutaneous group. Two wound complications and one rerupture were found in the open repair group. One case of deep venous thrombosis occurred in the percutaneous repair group. All complications occurred before 6 months after surgery. We identified no patients with nerve injury.


Percutaneous repair provides function similar to that achieved with open repair, with a better cosmetic appearance, a lower rate of wound complications, and no apparent increase in the risk of rerupture.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Achilles Tendon Wound Complication Open Repair Sural Nerve Repair Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Marcos Paleo Pineda who was chief of the foot and ankle service and operated on several patients; Leonardo Lagos Sepúlveda for checking and evaluating some of the patients; Juan Pablo Araya who was our physiotherapist; and Viviana Toro Ibacache who corrected the manuscript and helped us with the analyses.


  1. 1.
    Aktas S, Kocaoglu B. Open versus minimal repair with Achillon device. Foot Ankle Int. 2009;30:391–397.PubMedCrossRefGoogle Scholar
  2. 2.
    Amlang MH, Christiani P, Heinz P, Zwipp H. Percutaneous technique for Achilles tendon repair with the Dresden Instruments [in German]. Unfallchirurg. 2005;108:529–536.PubMedCrossRefGoogle Scholar
  3. 3.
    Amlang MH, Christiani P, Heinz P, Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden Instrument [in German and English]. Oper Orthop Traumatol. 2006;18:287–299.PubMedCrossRefGoogle Scholar
  4. 4.
    Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P. Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002;84:161–170.PubMedGoogle Scholar
  5. 5.
    Bradley JP, Tibone JE. Percutaneous and open repairs of Achilles tendon ruptures. Am J Sports Med. 1990;18:188–195.PubMedCrossRefGoogle Scholar
  6. 6.
    Buchgraber A, Pässler HH. Percutaneous repair of Achilles tendon rupture: immobilization versus functional postoperative treatment. Clin Orthop Relat Res. 1997;341:113–122.PubMedCrossRefGoogle Scholar
  7. 7.
    Carden DG, Noble J, Chalmers J, Lunn P, Ellis J. Rupture of the calcaneal tendon: the early and late management. J Bone Joint Surg Br. 1987;69:416–420.PubMedGoogle Scholar
  8. 8.
    Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg Br. 1989;71:100–101.PubMedGoogle Scholar
  9. 9.
    Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2008;16:204–209.PubMedCrossRefGoogle Scholar
  10. 10.
    Gillies H, Chalmers J. The management of fresh ruptures of the tendo Achilles. J Bone Joint Surg Am. 1970;52:337–343.PubMedGoogle Scholar
  11. 11.
    Goren D, Ayalon M, Nyska M. Isokinetic strength and endurance after percutaneous and open surgical repair of Achilles tendon ruptures. Foot Ankle Int. 2005;26:286–290.PubMedGoogle Scholar
  12. 12.
    Gorschewsky O, Pitzl M, Putz A, Klakow A, Neumann W. Percutaneous repair of acute Achilles tendon rupture. Foot Ankle Int. 2004;25:219–224.PubMedGoogle Scholar
  13. 13.
    Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendo Achilles repair. Foot Ankle Int. 2004;25:215–218.PubMedGoogle Scholar
  14. 14.
    Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 1978;6:107–111.PubMedCrossRefGoogle Scholar
  15. 15.
    Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2004;3:CD003674.PubMedGoogle Scholar
  16. 16.
    Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov. 1991;76:223–228.PubMedGoogle Scholar
  17. 17.
    Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–790.PubMedGoogle Scholar
  18. 18.
    Lea RB, Smith L. Non-surgical treatment of tendo Achilles rupture. J Bone Joint Surg Am. 1972;54:1398–1407.PubMedGoogle Scholar
  19. 19.
    Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:277–279.PubMedCrossRefGoogle Scholar
  20. 20.
    Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon. Foot Ankle Int. 2001;22:559–565.Google Scholar
  21. 21.
    Maes R, Copin G. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg. 2006;72:179–183.PubMedGoogle Scholar
  22. 22.
    Maffulli N. Current Concepts Review: Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81:1019–1036.PubMedGoogle Scholar
  23. 23.
    Majewski M, Rohrbach M, Czaja S, Ochsner P. Avoiding sural nerve injuries during percutaneous Achilles tendon repair Am J Sports Med. 2006;34:793–798.Google Scholar
  24. 24.
    Moller A, Astrom M, Westlin NE. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–481.PubMedCrossRefGoogle Scholar
  25. 25.
    Nilsson-Helander K, Thurin A, Karlsson J, Eriksson BI. High incidence of deep venous trombosis after Achilles tendon rupture: a prospective study. Knee Surg Sports Traumatol Arthrosc. 2009;17:1234–1238.PubMedCrossRefGoogle Scholar
  26. 26.
    Pässler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol. 1998;14:93–95.Google Scholar
  27. 27.
    Rippstein PF, Jung M, Assal M. Surgical repair of acute Achilles tendon rupture using a ‘mini-open’ technique. Foot Ankle Clin. 2002;7:611–619.PubMedCrossRefGoogle Scholar
  28. 28.
    Rowley DI, Scotland TR. Rupture of the Achilles tendon treated by a simple operative procedure. Injury. 1982;14:252–254.PubMedCrossRefGoogle Scholar
  29. 29.
    Suchak A, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 2005;26:932–936.PubMedGoogle Scholar
  30. 30.
    Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–880.PubMedCrossRefGoogle Scholar
  31. 31.
    Winter E, Weise K, Weller S, Ambacher T. Surgical repair of Achilles tendon rupture: comparison of surgical with conservative treatment. Arch Orthop Trauma Surg. 1998;117:364–367.PubMedCrossRefGoogle Scholar
  32. 32.
    Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–575.PubMedGoogle Scholar
  33. 33.
    Zwipp H, Südkamp N, Thermann H, Samek N. Rupture of the Achilles tendon: results of 10 years’ follow-up after surgical treatment. A retrospective study [in German]. Unfallchirurg. 1989;92:554–559.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Hugo Henríquez
    • 1
    Email author
  • Roberto Muñoz
    • 1
  • Giovanni Carcuro
    • 1
  • Christian Bastías
    • 1
  1. 1.Foot and Ankle Service, Instituto Traumatológico–University of ChileSantiagoChile

Personalised recommendations