Postoperative Complications After Acute Achilles Tendon Rupture Repair: A Survival Analysis of Minimally Invasive vs Open Techniques.

Background: The complication rates after surgical repair of acute Achilles tendon ruptures (ATRs) using open repair or minimally invasive surgical techniques (MIS) have been debated extensively. Despite significant research, a literature hiatus exists on the timing of these complications between techniques. In this study, we aimed to address this gap by conducting a Kaplan-Meier survival analysis to compare the incidence and timing of complications after open vs MIS repair of acute ATRs and examine associated risk factors.

Methods: This retrospective study included patients ≥18 years who underwent surgical treatment of an acute ATR within 28 days of injury and had a minimum of 90-day follow-up. Demographics, surgical technique (open vs MIS repair), and the occurrence and timing of postoperative complications were collected. Postoperative complications were classified as venous thromboembolism, rerupture, surgical site infection, wound dehiscence, and sural nerve injury. A Kaplan-Meier curve was employed to compare the complication rates between groups. The log-rank test was used to test the equality of survivor functions. The Cox proportional hazards model was used to determine predictors of complications.

Results: In total, out of 417 patients, 52 complications were reported in 50 patients. We found no significant difference in the complication rates between the MIS and open repair groups. Cox proportional hazards modeling revealed that BMI was a significant predictor of rerupture (HR 1.2, 95% CI 1.05-1.4) and that surgical delay increased the risk of wound dehiscence (HR 1.2, 95% CI 1.01-1.3) and sural nerve injury (HR 1.2, 95% CI 1.1-1.3).

Conclusion: MIS and open repair techniques for acute ATRs demonstrate comparable complication rates. However, patients with elevated BMI exhibit a modest increased risk of rerupture, regardless of the technique used. Those with surgical delay beyond 2 weeks are also modestly more likely to experience wound dehiscence with open surgical approach and sural nerve injury among MIS-treated patients.