title: Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis.
abstract: BACKGROUND
  Acute Achilles tendon rupture (AATR) is a frequent injury occurring dominantly in young to middle-aged males. Outcomes and complications between percutaneous and open repair are still controversial. Thus, the purpose of this meta-analysis is to evaluate the outcomes and complications of these two operative methods.
  
  
  METHODS
  We searched multiple databases: PubMed, Web of Science, EMBASE and the Cochrane Library up to October 2016. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by Rev Man 5.3 software.
  
  
  RESULTS
  Five randomized controlled trials (RCTs) and seven retrospective cohort studies involving 815 patients met the inclusion criteria. The sural nerve injury rate in the percutaneous group was significantly higher (RR = 3.52, 95%CI 1.45 to 8.57, P = 0.006). However, deep infection rate in the open group was higher (RR = 0.33, 95%CI 0.11 to 0.96, P = 0.04) and subgroup analysis of five RCTs showed no significant difference (RR = 0.42, 95%CI 0.09 to 2.10, P = 0.29). No significant difference was seen regarding the rate of re-rupture. The time of operation in the percutaneous group was shorter (RR = -1.99, 95%CI -3.81 to -0.80, P = 0.001). American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score showed statistically different in the two groups. Other functional outcomes were similar in the two groups.
  
  
  CONCLUSIONS
  Percutaneous repair has the advantages of operation time, deep infection and AOFAS score. The functional outcomes were similar in two treatment groups except AOFAS score. Despite the higher incidence of sural nerve injury, we still believe that percutaneous repair is superior to open repair for treating AATR.
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: yangbo209@foxmail.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: liuyang_orthopedics@foxmail.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: 153391132@qq.com.
authors.forename: Shunli
authors.initials: S
authors.lastname: Kan
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: 462570672@qq.com.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: xiaoranxuhong@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: sindy_1127188@163.com.
authors.forename: Feifei
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: ninggz_tmu@foxmail.com.
authors.forename: Guangzhi
authors.initials: G
authors.lastname: Ning
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address: sqfeng@tmu.edu.cn.
authors.forename: Shiqing
authors.initials: S
authors.lastname: Feng
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*
keywords: Acute Achilles tendon rupture; Metaanalysis; Open; Percutaneous