Both open and percutaneous techniques provide comparable functional outcomes in acute Achilles tendon rupture: study

Although various surgical techniques are applied in the treatment of Achilles tendon ruptures, the impact of rupture localization, particularly the distance from the insertion point on functional outcomes remains unclear.

Fatih Emre Topsakal et al conducted a study to investigate the relationship between rupture level, surgical timing, techniques, and patient-reported outcomes.

This retrospective study analyzed 32 patients (30 males, 2 females; median age 45 years, IQR (Interquartile Range): 35–55) who underwent surgical repair for acute Achilles tendon rupture. Patients were classified based on rupture location (proximal > 6 cm vs. distal ≤ 6 cm from calcaneal insertion), surgical timing (early ≤ 7 days vs. delayed > 7 days), and technique (open vs. percutaneous). Primary outcomes included Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores at minimum 6-month follow-up. Secondary outcomes included return to activity, complications, and patient satisfaction.

The key findings were -

• Complete rupture location data was available for 17 patients.

• Patients with distal ruptures showed numerically higher functional scores compared to proximal ruptures (ATRS: 88.1 +/- 7.5 vs. 80.4 +/- 11.2, p = 0.117; AOFAS: 93.5 +/- 4.0vs. 86.7 +/- 7.8, p = 0.089), though these differences did not reach statistical significance. The observed effect size was moderate to large (Cohen’s d = 0.808 for ATRS, d = 1.067 for AOFAS).

• Overall functional outcomes were favorable with median ATRS score of 87 (IQR: 80–92) and AOFAS score of 92 (IQR: 88–96).

• Clinical success rates indicated that 78.1% of patients achieved good or satisfactory results (ATRS ≥ 80 points) and 90.6% achieved AOFAS scores ≥ 85.

• No differences were observed between open and percutaneous repair techniques (ATRS: 84.2 +/- 10.1 vs. 86.5 +/- 9.2, p = 0.57).

• Early surgery (≤ 7 days) showed a trend toward higher scores compared to delayed surgery (ATRS: 86.0 +/- 9.5 vs. 80.2 +/- 11.8, p = 0.31), though this difference was not statistically significant.

• No major complications or re-ruptures occurred during follow-up.

The authors commented – “In conclusion, this study demonstrates that both open and percutaneous techniques provide comparable functional outcomes in the surgical management of acute Achilles tendon rupture, with the percutaneous approach offering fewer wound complications. Distal ruptures may be associated with superior clinical results compared to proximal tears, though statistical significance was not achieved. Although limited by a modest sample size and partial availability of anatomical measurements, an a priori power analysis confirmed sufficient statistical strength for primary outcomes. These findings highlight the importance of rupture localization, gap length, and early standardized rehabilitation in guiding clinical decision-making, and underscore the need for larger, multicenter studies to validate and expand upon these results.”

For further details on the article refer to:

Same Diagnosis, Diff erent Outcomes: Clinical Impact of Tear Level and Gap Distance in Achilles Tendon Ruptures

Fatih Emre Topsakal et al

Indian Journal of Orthopaedics (2026) 60:206–218

https://doi.org/10.1007/s43465-025-01592-2