title: Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures.
abstract: BACKGROUND
  Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures.
  
  
  METHODS
  Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision with FiberWire in a Krackow fashion reinforced with absorbable sutures. Patient demographics were recorded along with medical comorbidities, activity at injury, time from injury to surgery, length of follow-up, return to baseline activities by 5 months, and postoperative complications.
  
  
  RESULTS
  The most common activity during injury for both groups was basketball (PARS: 39%, open: 47%). A greater number of patients treated with PARS were able to return to baseline physical activities by 5 months compared with the open group (PARS: 98%, open: 82%; P = .0001). There were no significant differences (P > .05) between groups in rates of rerupture (P = 1.0), sural neuritis (P = .16), wound dehiscence (P = .74), superficial (P = .29) and/or deep infection (P = .29), or reoperation (P = .13). There were no deep vein thromboses (DVTs) or reruptures in either group. In the PARS group, there were no cases of sural neuritis, 3 cases (3%) of superficial wound dehiscence, and 2 reoperations (2%) for superficial foreign-body reaction to FiberWire. In the open group, there were 5 cases (3%) of sural neuritis, 7 cases (4%) of superficial wound dehiscence, 3 cases (2%) of superficial infection, and 3 reoperations (2%) for deep infection.
  
  
  CONCLUSIONS
  The present study reports the largest single-center series of acute Achilles tendon ruptures in the literature with lower complication rates for operatively treated Achilles ruptures compared with previous reports. The overall complication rate for all operatively treated Achilles ruptures was 8.5% with no reruptures, and most patients (88%) were able to return to baseline activities by 5 months after surgery. There were no significant differences in rates of postoperative complications between PARS and open repair for acute Achilles tendon ruptures.
  
  
  METHODS
  Level III, retrospective cohort study.
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA andyhsu1@gmail.com.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hsu
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
authors.forename: Carroll P
authors.initials: CP
authors.lastname: Jones
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Cohen
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
authors.forename: W Hodges
authors.initials: WH
authors.lastname: Davis
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
authors.forename: J Kent
authors.initials: JK
authors.lastname: Ellington
authors.affiliation: OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Anderson
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D001265:Athletic Injuries / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012421:Rupture; D016896:Treatment Outcome
keywords: Achilles tendon; PARS; complications; limited incision repair; open; rupture; treatment