This meta-analysis of 8 RCTs (358 patients) compared minimally invasive surgery to open repair for acute Achilles tendon rupture. It asked whether MIS reduces complications without sacrificing functional outcomes or increasing rerupture risk.
The wound complication problem with open Achilles repair is real and quantifiable: this meta-analysis puts a number on it (NNT = 10 to prevent one infection, NNT = 4 to prevent any complication). When you have a healthy patient under 60 with an acute Achilles rupture and no contraindications, MIS is the better choice for complication avoidance without giving up anything on rerupture rate or functional recovery.
For older patients or those with diabetes, vascular disease, or immunosuppression, the evidence base does not cover them — open repair or nonoperative treatment remains appropriate.
If you use a percutaneous technique, device selection and technique matter: the Ma and Griffith approach carries up to 60% sural nerve complication rates in clinical series, while device-based systems (Achillon, Tenolig) have a far lower profile. External rotation of the Achillon device during passage reduces nerve entrapment risk per cadaveric data.
This meta-analysis of 8 RCTs (358 patients) compared minimally invasive surgery to open repair for acute Achilles tendon rupture. It asked whether MIS reduces complications without sacrificing functional outcomes or increasing rerupture risk.
The wound complication problem with open Achilles repair is real and quantifiable: this meta-analysis puts a number on it (NNT = 10 to prevent one infection, NNT = 4 to prevent any complication). When you have a healthy patient under 60 with an acute Achilles rupture and no contraindications, MIS is the better choice for complication avoidance without giving up anything on rerupture rate or functional recovery.
For older patients or those with diabetes, vascular disease, or immunosuppression, the evidence base does not cover them — open repair or nonoperative treatment remains appropriate.
If you use a percutaneous technique, device selection and technique matter: the Ma and Griffith approach carries up to 60% sural nerve complication rates in clinical series, while device-based systems (Achillon, Tenolig) have a far lower profile. External rotation of the Achillon device during passage reduces nerve entrapment risk per cadaveric data.