Melinte Marian Andrei, Nistor Dan Viorel, de Souza Conde Rodrigo Arruda, Hernández Ricardo González, Wijaya Prajna, Marvin Kabuye, Moldovan Alexia Nicola, Melinte Razvan Marian
Pharmacy, Science, and Technology of Targu Mures, "George Emil Palade" University of Medicine, Strada Rasaritului nr. 10, Targu Mures, 540143, Romania.
1st Department of Orthopedics and Traumatology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 8 Victor Babes Street, Cluj-Napoca, 400012, Romania.
Int Orthop. 2025 Jan;49(1):259-269. doi: 10.1007/s00264-024-06362-7. Epub 2024 Oct 28.
To compare the clinical outcomes and complications of mini-open (MOT) and percutaneous techniques (PT) in the surgical repair of acute Achilles tendon rupture (AATR).
We systematically searched PubMed, Scopus, Web of Science, Clinical Trials, and the Cochrane Library for studies comparing MOT with PT for AATR. We assessed functional outcomes, complication rates, and operation time. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) were pooled with a fixed-effects model for dichotomous and continuous endpoints, respectively. Heterogeneity was evaluated with I statistics.
Eight studies, comprising 484 patients, were included, of whom 226 (46%) underwent MOT. MOT was associated with a significantly lower re-rupture rate (1.48% vs. 6.11%; OR 0.28; 95% CI 0.09-0.86; p = 0.03; I = 6%) and sural nerve injury rate (0.57% vs. 5.64%; OR 0.24; 95% CI 0.07-0.81; p = 0.02; I = 0%). No significant differences were observed in venous thrombosis (OR 0.81; 95% CI 0.17-3.94; p = 0.33; I = 0%), wound infection (OR 0.56; 95% CI 0.12-2.62; p = 0.46; I = 0%), or operation time (MD 1.83 min; 95% CI -1.13-4.79; p = 0.23; I = 88%). Functional outcomes showed higher American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores in the MOT group (MD 1.52 points; 95% CI 0.62-2.42; p = 0.001; I = 3%), while (Achilles Tendon Total Rupture Score) ATRS, time to return to activities, and ankle plantar and dorsiflexion were comparable.
MOT for AATR repair seems to reduce re-ruptures and sural nerve injuries while improving AOFAS scores, with no significant differences in other complications compared to PT. These findings suggest that the MOT may offer a safer and equally effective alternative to PT for AATR.
比较微创开放手术（MOT）与经皮技术（PT）治疗急性跟腱断裂（AATR）的临床疗效及并发症。
我们系统检索了PubMed、Scopus、Web of Science、临床试验和Cochrane图书馆，以查找比较MOT与PT治疗AATR的研究。我们评估了功能结局、并发症发生率和手术时间。使用RevMan Web进行统计分析。分别采用固定效应模型对二分类和连续型终点合并比值比（OR）和平均差（MD）及其95%置信区间（CI）。采用I统计量评估异质性。
纳入8项研究，共484例患者，其中226例（46%）接受了MOT。MOT组的再断裂率（1.48%对6.11%；OR 0.28；95%CI 0.09 - 0.86；p = 0.03；I = 6%）和腓肠神经损伤率（0.57%对5.64%；OR 0.24；95%CI 0.07 - 0.81；p = 0.02；I = 0%）显著更低。在静脉血栓形成（OR 0.81；95%CI 0.17 - 3.94；p = 0.33；I = 0%）、伤口感染（OR 0.56；95%CI 0.12 - 2.62；p = 0.46；I = 0%）或手术时间（MD 1.83分钟；95%CI -1.13 - 4.79；p = 0.23；I = 88%）方面未观察到显著差异。功能结局方面，MOT组的美国矫形足踝协会（AOFAS）踝 - 后足评分更高（MD 1.52分；95%CI 0.62 - 2.42；p = 0.001；I = 3%），而跟腱完全断裂评分（ATRS）、恢复活动时间以及踝关节跖屈和背屈情况相当。
MOT修复AATR似乎可降低再断裂和腓肠神经损伤的发生率，同时提高AOFAS评分，与PT相比，在其他并发症方面无显著差异。这些发现表明，对于AATR，MOT可能为PT提供一种更安全且同样有效的替代方法。
