Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review.

INTRODUCTION: This review provides a comprehensive description of clinical, functional outcomes, and complications after open and minimally invasive surgery for Achilles tendon ruptures. SOURCES OF DATA: We systematically searched Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports Discus and Google scholar databases using the combined keywords 'open repair', 'percutaneous surgery', 'minimally invasive surgery' 'Achilles tendon rupture', 'complications', 'infections', 'wound disorders' to identify articles published in English, Spanish, French and Italian. AREAS OF AGREEMENT: Twelve studies fulfilled our inclusion criteria. Six studies were retrospective, five were randomized controlled trials and one was a prospective investigation. Of a total of 781 patients, 375 underwent open repair and 406 percutaneous surgery. Different procedures were performed for open and minimally invasive repair. AREAS OF CONTROVERSY: The range of motion was significantly greater after percutaneous repair than open surgery. The number of complications that occurred after open surgery was higher than after minimally invasive surgery. GROWING POINTS: Minimally invasive surgery is less expensive and less time demanding. AREAS TIMELY FOR DEVELOPING RESEARCH: Minimally invasive and open surgery of the Achilles tendon are grossly equivalent. However, iatrogenic neurological complications are more frequent after percutaneous repair. Novel percutaneous repairs have been proposed to minimize the risk of sural nerve injury.