DOI: 10.1177/24730114261466664 ISSN: 2473-0114

Results of Achilles Insertional Repair Techniques: Minimally Invasive Compared to Open Repair

Jorge I. Acevedo, Sofia Rivera, Kelsey A. Crawford, Lauren Barnes, David E. Jaffe, John Chao, Dominic S. Carreira
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Background:

Insertional Achilles tendinopathy (IAT) is a common yet challenging condition that often resists conservative treatment. Traditional open surgical repair carries risk of complications including delayed wound healing and infection. This study compares the outcomes of a minimally invasive surgical (MIS) technique using arthroscopic-assisted double-row repair vs open repair.

Methods:

Fifty-six patients with IAT underwent surgical intervention between June 2021 and September 2024 (32 MIS, 24 open). Patient-reported outcomes (PROs) were assessed pre- and post-operatively with a minimum 1-year follow-up. Six patients were excluded from analysis for comparability between groups. Statistical analysis used 2-tailed t tests with a Bonferroni adjustment (α = 0.05/3 = 0.0167). The proportion of each cohort reaching the minimal clinically important difference (MCID) was compared via χ 2 analysis, and complications were correlated to body mass index (BMI) and age using logistic regression analyses. Sensitivity analyses using multiple linear regressions, adjusted for follow-up time, were performed on the full cohort (α = 0.05).

Results:

The MIS group had significantly worse preoperative scores compared with the open group. But at a mean follow-up of 2.2 years for the MIS group and 2.0 years for the open group, the MIS group demonstrated significantly greater improvements in Patient-Reported Outcomes Measurement Information System physical function and visual analog scale scores ( P  < .001 for both) and a significantly greater proportion of patients at MCID ( P  < .05 for both). Foot and Ankle Ability Measure activities of daily living subscale showed similar findings without significance detected. All PROs retained significance on sensitivity analysis. Complication rates were 0% in the MIS group and 5.0% in the open group with no correlation to BMI or age.

Conclusion:

Despite limitations necessitating further studies, our results begin to suggest superior functional outcomes following MIS repair for IAT compared to traditional open repair, supporting MIS as a potentially safer and more effective alternative for appropriate patients.

Level of Evidence:

Level III, retrospective comparative study.

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