Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2021 ◽  
pp. 036354652110536
Author(s):  
Ahmed Khalil Attia ◽  
Karim Mahmoud ◽  
Pieter d’Hooghe ◽  
Jason Bariteau ◽  
Sameh A. Labib ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Sural Nerve ◽  
Open Repair ◽  
Meta Analysis ◽  
Deep Infection ◽  
Surgical Time ◽  
Significant Difference ◽  
Tendon Ruptures ◽  
The Mean

Background: An acute Achilles tendon rupture is one of the most common sports injuries, affecting 18 per 100,000 persons, and its operative repair has been evolving and increasing in frequency since the mid-1900s. Traditionally, open surgical repair has provided improved functional outcomes, reduced rerupture rates, and a quicker recovery and return to activities at the expense of increased wound complications such as infections and skin necrosis compared with nonoperative management. In 1977, Ma and Griffith introduced the percutaneous approach, and over the following decades, multiple improved techniques, and modifications thereof, have been described with comparable outcomes with open repair. Purpose: The current study aimed to provide updated level 1 evidence comparing open repair with minimally invasive surgery (MIS) through a comprehensive search of the literature published in English, Arabic, Spanish, Portuguese, and German while avoiding limitations of previous studies such as heterogeneous study designs and a small number of included trials. Study Design: Meta-analysis; Level of evidence, 1. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases to identify randomized controlled trials (RCTs) comparing open repair and MIS of Achilles tendon ruptures. The primary outcomes were (1) functional outcomes, (2) reruptures, (3) sural nerve injuries, and (4) infections (deep/superficial), whereas the secondary outcomes were (1) skin complications, (2) adhesions, (3) other complications, (4) ankle range of motion, and (5) surgical time. Results: There were 10 RCTs that qualified for the meta–analysis with a total of 522 patients. Overall, 260 (49.8%) patients underwent open repair, while 262 (50.2%) underwent MIS. The mean postoperative AOFAS score was 94.8 and 95.7 for open repair and MIS, respectively, with a nonsignificant difference (mean difference [MD], –0.73 [95% CI, –1.70 to 0.25]; P = .14; I2 = 0%). The pooled mean total complication rate was 15.5% (0%-36.4%) for open repair and 10.4% (0%-45.5%) for MIS, with a nonsignificant statistical difference (odds ratio [OR], 1.50 [95% CI, 0.87-2.57]; P = .14; I2 = 40%). The mean rerupture rate was 2.5% (0%-6.8%) for open repair versus 1.5% (0%-4.6%) for MIS, with a nonsignificant statistical difference (OR, 1.56 [95% CI, 0.42-5.70]; P = .50; I2 = 0%). No cases of sural nerve injuries were reported in the open repair group. The mean sural nerve injury rate was 3.4% (0%-7.3%) in the MIS group, which was statistically significant (OR, 0.16 [95% CI, 0.03-0.46]; P = .02; I2 = 0%). The mean overall superficial infection rate was 6.0% (0%-18.2%) and 0.4% (0%-4.5%) for open repair and MIS, respectively, with a statistically significant difference (OR, 5.70 [95% CI, 1.80-18.02]; P < .001; I2 = 0%). The mean overall deep infection rate reported in the open repair group was 1.4% (0%-5.0%), while no deep infection was reported in the MIS group, with no statistically significant difference (OR, 3.14 [95% CI, 0.48-20.54]; P = .23; I2 = 0%). There were no significant differences between the open repair and MIS groups in the skin necrosis and dehiscence rate, adhesion rate, or keloid scar rate. The mean surgical time was 51.0 and 29.7 minutes for open repair and MIS, respectively, with a statistically significant difference (MD, 21.13 [95% CI, 15.50-26.75]; P < .001; I2 = 15%). Conclusion: Open Achilles tendon repair was associated with a longer surgical time, higher risk of superficial infections, and higher risk of ankle stiffness, while MIS was associated with a greater risk of temporary sural nerve palsy. The rerupture rate and functional outcomes were mostly equivalent. We found MIS to be a safe and reliable technique. However, high–quality standardized RCTs are still needed before recommending MIS as the gold standard for managing Achilles tendon ruptures.

scholarly journals Clinical Outcomes of Acute Achilles Tendon Rupture Repair Utilizing Supine Positioning

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Ryan Rogero ◽  
David Beck ◽  
Joseph Larwa ◽  
Daniel Fuchs ◽  
Steven M. Raikin
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Supine Position ◽  
Functional Outcomes ◽  
Open Repair ◽  
Tendon Repair ◽  
Complication Rates ◽  
Achilles Tendon Repair ◽  
Functional Scores ◽  
Tendon Ruptures

Category: Sports, Trauma Introduction/Purpose: With no consensus regarding the optimal technique for repair of Achilles tendon ruptures, identifying techniques which minimize complications and maximize functional outcomes is essential. Previous studies on Achilles repair performed in the supine position have demonstrated low complication rates, avoidance of issues related to anesthesia set-up of prone positioning, and decreased operating room times, though these studies have included relatively low patient numbers and lacked functional outcomes. The purpose of this study is to evaluate the clinical outcomes of a large cohort of patients undergoing acute Achilles tendon repair in the supine position. Methods: We conducted a retrospective review of patients undergoing open repair of acute Achilles tendon ruptures with supine positioning by one fellowship-trained foot & ankle surgeon at a single outpatient surgical location from 2010-2016. During each procedure, a longitudinal incision was made just medial to the tendon extending approximately 3.5 cm both proximally and distally from the level of the rupture. Exclusion criteria included age <18 years old, repair >21 days from date of injury, and undergoing any additional procedures other than concomitant tendon transfers. Postoperative chart notes were reviewed to identify any complications experienced by patients, and surgical site records were reviewed for tourniquet times. Patients were contacted and asked about their satisfaction with surgical outcome and to complete the Foot & Ankle Ability Measure (FAAM)- Activities of Daily Living (ADL) and –Sports subscales, as well as the Visual Analog Scale (VAS) for pain. Results: Two-hundred eleven patients, including 31 (14.7%) females, were included in the study, with a mean age of 40.9 years and mean BMI of 28.8 kg/m2. Patients had an average of duration from injury to surgery of 8.5 days (range, 1-21 days) and mean tourniquet time of 35.5 minutes (range, 16-77 minutes). Four patients (1.9%) experienced a postoperative complication, including 2 superficial wound infections and 2 deep vein thromboses. There were no sural nerve-related injuries or tendon re-ruptures. At an average of 56.8 months postoperatively (range 24-99 months), patients reported a mean VAS pain of 0.6 ± 1.3/10 and mean FAAM-ADL and FAAM-Sports scores of 93.9 ± 12.4/100 and 84.7 ± 19.6/100, respectively. Additionally, 91.4% reported being satisfied with the outcome of the surgery. Conclusion: With an extremely low complication rate, mid- to long-term functional scores comparable to other reported Achilles tendon repair techniques, and high rate of patient satisfaction, open repair of Achilles tendon ruptures performed in a supine position offers surgeons a safe and effective treatment method.

scholarly journals Return to Play After Mini-Open Repair of Achilles Tendon Ruptures in the NFL Athlete

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Stephen Greenfield ◽  
Robert Anderson
Keyword(s):  
Achilles Tendon ◽  
Performance Metrics ◽  
Open Repair ◽  
Return To Sport ◽  
Return To Play ◽  
Post Injury ◽  
Significant Difference ◽  
Tendon Ruptures ◽  
The Impact ◽  
Mini Open

Category: Sports Introduction/Purpose: Non-insertional Achilles tendon ruptures are a devastating injury in the National Football League (NFL) athlete. Depending on timing, these often are season ending injuries. There are mixed reports in the literature regarding impact of Achilles injuries in elite athletes. Additionally, there have been advancements in techniques including a mini-open repair that has proven successful. The purpose of this study was to critically analyze a large, single surgeon series of non-insertional Achilles ruptures in NFL athletes treated with a mini-open technique. Our primary focus was to determine return to play and evaluate possible contributing factors that affect this. Additionally, we sought to compare pre and post injury performance for those who successfully returned to the NFL. Methods: NFL athletes treated for non-insertional Achilles ruptures since 2012 were included. Demographic and performance data were obtained from the NFL.com player database and included position, age, years in the league, return to sport and relevant performance metrics listed below. Pre injury frequency of play (games played per total games in season) for athletes were recorded. The impact of injury on performance after return to sport was assessed by comparing data from two years prior and two years post injury, normalized to a “per game” basis. For defensive players, specific metrics included tackles, pass deflection, interceptions and sacks. For offensive players, rushing and receiving statistics for running backs and wide receivers/tight ends were recorded, respectively. Average yards per run/catch, attempts per game, number of 20+ yard plays and touchdowns were recorded. Data was analyzed with Welch’s method 2-Sample t test in Minitab. Results: Thirty-five ruptures were identified in predominantly defensive players (25/35). Ruptures occurred, on average, at age 27.7 years with 4.1 years of NFL experience. There was no significant difference in offensive (70%) and defensive (76%) player’s ability to return to the NFL (p=1.0). The frequency of play in the two seasons prior to injury differed significantly for players who did not return (21%) compared to those who did (95%) (p=.0013). Due to limited skill-position offensive players, further sub- analysis was limited. Defensive players who returned demonstrated significant differences in performance pre-injury compared to players who failed to return. In the two years following injury, returning defensive players performed at near baseline compared to pre injury statistics (figure 1). Conclusion: Achilles injuries occurred predominately in defensive players. Typically occurring past the average NFL career length, it represents a mid to late career injury. The comeback rate of 74% is excellent and is higher than previously reported. Those who failed to return were utilized less frequently pre-injury and had poorer performance statistics (defensive), indicating less talented players were impacted to a greater extent. Lastly, given limited or no differences found in productivity for those who returned, we conclude that while an Achilles injury is most often season ending, most skilled players are able to return with little impact on performance.

scholarly journals Short-term Outcomes of Open “Crown” Type v. Percutaneous Bunnell Type Repair of Acute Achilles Tendon Ruptures. Randomized Control Study

2020 ◽  
Vol 19 (3-4) ◽  
pp. 101-108
Author(s):  
Aleksas Makulavičius ◽  
Giedrius Mazarevičius ◽  
Povilas Masionis ◽  
Matas Urmanavičius ◽  
Mindaugas Klinga ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Achilles Tendon ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Deep Infection ◽  
Percutaneous Technique ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Tendon Ruptures ◽  
Group B

Background. The optimal treatment of acute Achilles tendon ruptures is still under debate. The purpose of this randomized controlled trial was to evaluate outcomes of open repair comparing with percutaneous procedure for Achilles tendon ruptures. Methods. 100 patients with acute Achilles tendon rupture were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). Absorbable suture was used in both groups. 87 patients were available for the mean follow up of 6 months. Results. No statistically significant difference was observed between groups in ATRS (Achilles Tendon Total Rupture Score), leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. Conclusions. Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.

scholarly journals Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?

2017 ◽  
Vol 2 (2) ◽  
pp. 247301141769983 ◽  
Author(s):  
Meghan E. Bishop ◽  
Carly D. Comer ◽  
Justin M. Kane ◽  
Mitchell G. Maltenfort ◽  
Steven M. Raikin
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Local Treatment ◽  
Retrospective Chart Review ◽  
Additional Treatment ◽  
Operative Intervention ◽  
Wound Complications ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Tendon Ruptures

Background: Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. Methods: A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. Results: There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected ( P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified—a significantly lower complication rate than that reported in the literature ( P < .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature ( P < .0001; CI 0.067-1.94). Conclusion: In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients’ overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level of Evidence: Level IV.

Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation

2021 ◽  
pp. 019459982199066
Author(s):  
Sandra Ho ◽  
Prayag Patel ◽  
Daniel Ballard ◽  
Richard Rosenfeld ◽  
Sujana Chandrasekhar
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Stapes Surgery ◽  
Chorda Tympani Nerve ◽  
Stapes Fixation ◽  
Operative Outcomes ◽  
Significant Difference ◽  
The Mean ◽  
Postoperative Vertigo ◽  
Hearing Outcomes

Objective To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. Data Sources PubMed, Embase, and Web of Science. Review Methods An electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. Results The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.

EXPRESS: Comparison of Mothership versus Drip-and-Ship Models in treating patients with Acute Ischemic Stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110132
Author(s):  
Ahmed Mohamed ◽  
Nida Fatima ◽  
Ashfaq Shuaib ◽  
Maher Saqqur
Keyword(s):  
Functional Outcome ◽  
Meta Analysis ◽  
Critical Time ◽  
Functional Independence ◽  
Models Of Care ◽  
Randomized Control Trials ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
The Mean ◽  
Randomized Control

Introduction There is controversy if direct to comprehensive center “mothership” (MS) or stopping at primary center for thrombolysis before transfer to comprehensive center “drip-and- ship” (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared. Results A total of 7,824 patients’ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptom’s onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care. Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

2010 ◽  
Vol 100 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shay Tenenbaum ◽  
Niv Dreiangel ◽  
Ayal Segal ◽  
Amir Herman ◽  
Amnon Israeli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Demographic Data ◽  
Achilles Tendon Rupture ◽  
Treatment Modalities ◽  
Main Concern ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Significant Difference ◽  
The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

2021 ◽  
pp. 112070002098506
Author(s):  
James R Onggo ◽  
Mithun Nambiar ◽  
Jason D Onggo ◽  
Anuruban Ambikaipalan ◽  
Parminder J Singh ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Non Union ◽  
Lag Screw ◽  
Significant Difference ◽  
Lower Complication ◽  
Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

scholarly journals Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

2020 ◽  
Author(s):  
Yongliang Yang ◽  
Honglei Jia ◽  
Wupeng Zhang ◽  
Shihong Xu ◽  
Fu Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Intraoperative Ultrasonography ◽  
Medial Side ◽  
Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.

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