Minimally Invasive versus Open Surgery for Acute Achilles Tendon Ruptures – A Systematic Review and Meta-analysis.

Background: The minimally invasive surgery (MIS) approach has been popularised as an alternative to the standard open approach in acute Achilles tendon repair. Advocates of MIS suggest earlier functional recovery, due to reduced trauma to adjacent soft tissues. Critics, however, argue that due to inadequate surgical exposure, complications of such surgery are higher compared to an open technique. Methods: A systematic review and meta-analysis of randomised, prospective studies weas conducted to compare MIS and open surgery in acute Achilles tendon ruptures. Results: Thirteen studies were included in the meta-analysis with a total of 854 patients. Although re-rupture rates were not significantly different between the groups ( P = 0.43), there were significantly more complications in the open surgery group ( P = <.00001). Conclusions: MIS in acute achilles tendon ruptures result in similar re-rupture rates, sural nerve injury rates and return to sport time in comparison with open surgical method, but with significantly less post-operative complications.