Open and Percutaneous Approaches Have Similar Biomechanical Results for Primary Midsubstance Achilles Tendon Repair: A Meta-analysis

Abstract

PurposeTo evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. MethodsA systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilize a laboratory design using either human or animal tissue, and directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either a locking or non-locking suture construct. The biomechanical outcomes evaluated were displacement (mm) and load to failure (N). ResultsTwelve studies met inclusion criteria, including 234 specimens (open: 97, percutaneous locking: 73; percutaneous non-locking: 64) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p=0.240) or load to failure (p=0.912) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p=0.109) between the locking and non-locking tendon repair systems. ConclusionThe results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. Clinical RelevanceIn clinical studies, similar re-rupture rates have been observed after open or percutaneous Achilles tendon repair. It may be beneficial for surgeons to understand whether biomechanical differences exist between these repair techniques.