Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jan;49(1):259-269.
doi: 10.1007/s00264-024-06362-7. Epub 2024 Oct 28.

Mini-open versus percutaneous surgical repair for acute Achilles tendon rupture: a systematic review and meta-analysis

Marian Andrei Melinte  1 , Dan Viorel Nistor  2 , Rodrigo Arruda de Souza Conde  3 , Ricardo González Hernández  4 , Prajna Wijaya  5 , Kabuye Marvin  6 , Alexia Nicola Moldovan  7 , Razvan Marian Melinte  2   8   9
Affiliations
Meta-Analysis

Mini-open versus percutaneous surgical repair for acute Achilles tendon rupture: a systematic review and meta-analysis

Marian Andrei Melinte et al. Int Orthop. 2025 Jan.

Abstract

Purpose: To compare the clinical outcomes and complications of mini-open (MOT) and percutaneous techniques (PT) in the surgical repair of acute Achilles tendon rupture (AATR).

Methods: We systematically searched PubMed, Scopus, Web of Science, Clinical Trials, and the Cochrane Library for studies comparing MOT with PT for AATR. We assessed functional outcomes, complication rates, and operation time. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) were pooled with a fixed-effects model for dichotomous and continuous endpoints, respectively. Heterogeneity was evaluated with I2 statistics.

Results: Eight studies, comprising 484 patients, were included, of whom 226 (46%) underwent MOT. MOT was associated with a significantly lower re-rupture rate (1.48% vs. 6.11%; OR 0.28; 95% CI 0.09-0.86; p = 0.03; I2 = 6%) and sural nerve injury rate (0.57% vs. 5.64%; OR 0.24; 95% CI 0.07-0.81; p = 0.02; I2 = 0%). No significant differences were observed in venous thrombosis (OR 0.81; 95% CI 0.17-3.94; p = 0.33; I2 = 0%), wound infection (OR 0.56; 95% CI 0.12-2.62; p = 0.46; I2 = 0%), or operation time (MD 1.83 min; 95% CI -1.13-4.79; p = 0.23; I2 = 88%). Functional outcomes showed higher American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores in the MOT group (MD 1.52 points; 95% CI 0.62-2.42; p = 0.001; I2 = 3%), while (Achilles Tendon Total Rupture Score) ATRS, time to return to activities, and ankle plantar and dorsiflexion were comparable.

Conclusions: MOT for AATR repair seems to reduce re-ruptures and sural nerve injuries while improving AOFAS scores, with no significant differences in other complications compared to PT. These findings suggest that the MOT may offer a safer and equally effective alternative to PT for AATR.

Keywords: AOFAS; Achilles; Limited open; Meta-analysis; Mini-open; Percutaneous.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: This is a meta-analysis; no ethical approval was required to commence the study. Consent to participate: Not applicable as this is a meta-analysis. Consent for publication: All the authors consent to publish this paper Competing interests: All authors report no relationships that could be construed as a conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, and other sources. Research Rabbit* is an artificial intelligence (AI) based tool that was used to do “backward snowballing” on all included papers. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71
Fig. 2
Fig. 2
A In patients with acute Achilles tendon rupture, the mini-open technique was associated with reduced re-ruptures compared to the percutaneous technique. B In patients with acute Achilles tendon rupture, the mini-open technique was associated with reduced sural nerve injuries compared to the percutaneous technique. C Peto fixed-effect model showed that in patients with acute Achilles tendon rupture, there was no significant difference in venous thrombosis between the mini-open and the percutaneous technique. D Peto fixed-effect model showed that in patients with acute Achilles tendon rupture, there was no significant difference in wound infection (superficial and deep) between the mini-open and the percutaneous technique
Fig. 3
Fig. 3
A In patients with acute Achilles tendon rupture, the AOFAS score was significantly higher in the mini-open group compared to the percutaneous group. B In patients with acute Achilles tendon rupture, the ATRS score was not different between the mini-open group and the percutaneous group. C In patients with acute Achilles tendon rupture, the time to return to previous activity was similar between the mini-open group and the percutaneous group. D In patients with acute Achilles tendon rupture, operating time was similar between the mini-open group and the percutaneous group. E In patients with acute Achilles tendon rupture, ankle plantar flexion was similar between the mini-open group and the percutaneous group. F In patients with acute Achilles tendon rupture, ankle dorsiflexion was similar between the mini-open group and the percutaneous group
See this image and copyright information in PMC

References

    1. Subaşı İÖ, Çepni Ş, Tanoğlu O et al (2023) A clinical comparison of two different surgical techniques in the treatment of acute Achilles tendon ruptures: limited-open approach vs. percutaneous approach. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES 29:935–943. 10.14744/tjtes.2023.90839 - PMC - PubMed
    1. Briggs-Price S, Mangwani J, Houchen-Wolloff L et al (2024) Incidence, demographics, characteristics and management of acute Achilles tendon rupture: an epidemiological study. PLoS ONE 19:e0304197. 10.1371/journal.pone.0304197 - PMC - PubMed
    1. Svedman S, Marcano A, Ackermann PW et al (2024) Acute Achilles tendon ruptures between 2002–2021: sustained increased incidence, surgical decline and prolonged delay to surgery-a nationwide study of 53 688 ruptures in Sweden. BMJ Open Sport Exerc Med 10:e001960. 10.1136/bmjsem-2024-001960 - PMC - PubMed
    1. Sheth U, Wasserstein D, Jenkinson R et al (2017) The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Jt J 99–B:78–86. 10.1302/0301-620X.99B1.BJJ-2016-0434.R1 - PubMed
    1. Myhrvold SB, Brouwer EF, Andresen TKM et al (2022) Nonoperative or Surgical Treatment of Acute Achilles’ Tendon rupture. N Engl J Med 386:1409–1420. 10.1056/NEJMoa2108447 - PubMed

MeSH terms

LinkOut - more resources