Clinical efficacy comparison of early accelerated rehabilitation with minimal incision and traditional open surgery in the treatment of acute Achilles&nbsp; tendon rupture

doi:10.13418/j.issn.1001-165x.2025.3.17

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Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (3) : 358-365. DOI: 10.13418/j.issn.1001-165x.2025.3.17

Clinical efficacy comparison of early accelerated rehabilitation with minimal incision and traditional open surgery in the treatment of acute Achilles tendon rupture

Chen Haoming¹, Huang Juanyu², Huang Yiyuan¹, Zeng Canjun¹, Li Runguang¹*

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Abstract

Objective To compare retrospectively the efficacy of small incision and traditional open repair combined with early accelerated rehabilitation in the treatment of acute Achilles tendon rupture. Methods Patients with acute Achilles tendon rupture were divided into a small incision group (n=22) and an open group (n=23) for surgical treatment. All patients underwent early accelerated rehabilitation. Postoperative Achilles Tendon Rupture Score (ATRS), Visual Analog Scale (VAS) score, imaging examination, incidence of secondary injury, Achilles tendon re-rupture rate, operation time, hospitalization time, return to sports time and patient satisfaction were analyzed. Results The ATRS of the small incision group was higher than that of the open group 3 months after surgery. There was no significant difference in the postoperative VAS score and ATRS 12 months after surgery between the two groups. In the small incision group and the open group, 1/1 case had superficial tissue infection and 1/3 had deep tissue infection. No re-rupture cases were found in the imaging examination of the two groups 1 year after surgery. The patients with "high satisfaction" of the small incision group was higher than that of the open group. Conclusions Based on the early accelerated rehabilitation program, both small incision and traditional open repair can achieve better therapeutic effects for patients, but the patients in the small incision group have higher postoperative satisfaction with the incision and faster postoperative recovery. Therefore, small incision repair technology combined with early accelerated rehabilitation program can be used as a feasible choice for surgical treatment of acute Achilles tendon rupture.

Key words

Acute Achilles tendon rupture; / Surgical treatment; / Accelerated rehabilitation; / / Complications; / / Sural nerve

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Chen Haoming, Huang Juanyu, Huang Yiyuan, Zeng Canjun, Li Runguang. Clinical efficacy comparison of early accelerated rehabilitation with minimal incision and traditional open surgery in the treatment of acute Achilles tendon rupture[J]. Chinese Journal of Clinical Anatomy. 2025, 43(3): 358-365 https://doi.org/10.13418/j.issn.1001-165x.2025.3.17

References

[1] Park S-H, Lee H S, Young K W, et al. Treatment of Acute Achilles Tendon Rupture [J]. Clin Orthop Surg, 2020, 12(1): 1-8. DOI: 10.4055/cios.2020.12.1.1.
[2] 陈传煌, 杨涛, 李文庆, 等. 急性跟腱断裂微创与传统修复方法的比较 [J]. 中国临床解剖学杂志, 2014, 32(4): 487-490. DOI: 10.13418/j.issn.1001-165x.2014.04.028.
Chen CH, Yang T, Li WQ, et al. Minimally invasive versus conventional method repair of acute Achilles tendon rupture [J]. Chinese Journal of Clinical Anatomy, 2014, 32(4): 487-490. DOI: 10.13418/j.issn.1001-165x.2014.04.028.
[3] Grassi A, Amendola A, Samuelsson K, et al. Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery [J]. J Bone Joint Surg Am, 2018, 100(22): 1969-1981. DOI: 10.2106/JBJS.17.01364.
[4] Attia AK, Mahmoud K, D'hooghe P, et al. Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials [J]. Am J Sports Med, 2023, 51(3): 825-836. DOI: 10.1177/03635465211053619.
[5] Patel MS, Kadakia AR. Minimally Invasive Treatments of Acute Achilles Tendon Ruptures [J]. Foot Ankle Clin, 2019, 24(3): 399-424. DOI: 10.1016/j.fcl.2019.05.002.
[6] Bragg JT, Ruelos VCB, Mcintyre JA, et al. Reverse Fragility Index Comparing Rates of Rerupture After Open Achilles Tendon Repair Versus Early Functional Rehabilitation: A Systematic Review of Randomized Controlled Trials [J]. Am J Sports Med, 2024, 52(4): 1116-1121. DOI: 10.1177/03635465231178831.
[7] Porter MD, Shadbolt B. Randomized controlled trial of accelerated rehabilitation versus standard protocol following surgical repair of ruptured Achilles tendon [J]. ANZ J Surg, 2015, 85(5): 373-377. DOI: 10.1111/ans.12910.
[8] Irfan SA, Ahmed S, Ashkar A, et al. Comparative effectiveness of weight-bearing strategies on functional recovery in acute Achilles tendon rupture: A network meta-analysis [J]. Foot Ankle Surg, 2025. DOI: 10.1016/j.fas.2025.02.013.
[9] Braunstein M, Baumbach SF, Boecker W, et al. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair [J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(3): 846-853. DOI: 10.1007/s00167-015-3795-1.
[10]Gould HP, Bano JM, Akman JL, et al. Postoperative Rehabilitation Following Achilles Tendon Repair: A Systematic Review [J]. Sports Med Arthrosc Rev, 2021, 29(2): 130-145. DOI: 10.1097/JSA.0000000000000309.
[11]Won Lee K, Bae J-Y, Ho BC, et al. Immediate Weightbearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair [J]. J Foot Ankle Surg, 2022, 61(3):604-608. DOI: 10.1053/j.jfas.2021. 10.021.
[12]Maempel JF, Clement ND, Duckworth AD, et al. A Randomized Controlled Trial Comparing Traditional Plaster Cast Rehabilitation With Functional Walking Boot Rehabilitation for Acute Achilles Tendon Ruptures [J]. Am J Sports Med, 2020, 48(11): 2755-2764. DOI: 10.1177/0363546520944905.
[13]Xu XY, Gao S, Lv Y, et al. Duration of immobilisation after Achilles tendon rupture repair by open surgery: a retrospective cohort study [J]. J Orthop Surg Res, 2021, 16(1): 196. DOI: 10.1186/s13018-021-02342-4.
[14]Valkering K P, Aufwerber S, Ranuccio F, et al. Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial [J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(6): 1807-1816. DOI: 10.1007/s00167-016-4270-3.
[15]Liu X, Dai TJ, Li BL, et al. Early functional rehabilitation compared with traditional immobilization for acute Achilles tendon ruptures : a meta-analysis [J]. Bone Joint J, 2021, 103-B(6): 1021-1030. DOI: 10.1302/0301-620X.103B6.BJJ-2020-1890.R1.
[16]Marrone W, Andrews R, Reynolds A, et al. Rehabilitation and Return to Sports after Achilles Tendon Repair [J]. Int J Sports Phys Ther, 2024, 19(9): 1152-1165. DOI: 10.26603/001c.122643.
[17]Mccormack R, Bovard J. Early functional rehabilitation or cast immobilisation for the postoperative management of acute Achilles tendon rupture? A systematic review and meta-analysis of randomised controlled trials [J]. Br J Sports Med, 2015, 49(20): 1329-1335. DOI: 10.1136/bjsports-2015-094935.
[18]Bak BM, Seow D, Teo YZE, et al. Return to Play and Functional Outcomes Following Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-Analysis [J]. J Foot Ankle Surg, 2024, 63(3): 420-429. DOI: 10.1053/j.jfas.2023.12.008.
[19]Langberg H, Rosendal L, Kjaer M. Training-induced changes in peritendinous type I collagen turnover determined by microdialysis in humans [J]. J Physiol, 2001, 534(Pt 1): 297-302. DOI:
[20]Jin WT, Huang LF, Guo HH, et al. Two mini transverse-incision repair yields better results than percutaneous repair for acute closed midsubstance Achilles tendon rupture: a retrospective case-control study [J]. J Orthop Surg Res, 2024, 19(1): 452. DOI: 10.1186/s13018-024-04904-8.
[21]Gatz M, Driessen A, Eschweiler J, et al. Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study [J]. Arch Orthop Trauma Surg, 2021, 141(3): 383-401. DOI: 10.1007/s00402-020-03437-z.
[22]熊洪涛, 庄永青, 傅小宽, 等. 两种入路手术治疗闭合性跟腱断裂43例临床分析 [J]. 中国临床解剖学杂志, 2017, 35(3): 322-326. DOI: 10.13418/j.issn.1001-165x.2017.03.018.
Xiong HT, Zhuang YQ, Fu XK, et al. Clinical analysis of two surgical approaches for treatment of closed rupture of Achilles tendon in 43 cases [J]. Chinese Journal of Clinical Anatomy, 2017, 35(3): 322–326. DOI: 10.13418/j.issn.1001-165x.2017.03.018.
[23]Xu L, Jin J, Liu Z, et al. A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini-incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study [J]. Orthop Surg, 2023, 15(2): 517-524. DOI: 10.1111/os.13615.
[24]Wei S, Chen J, Kong C, et al. Endoscopic "internal splinting" repair technique for acute Achilles tendon rupture [J]. Arch Orthop Trauma Surg, 2021, 141(10): 1753-1760. DOI: 10.1007/s00402-021-03818-y.