Vol. 9, Issue 2, Part A (2025)

Background: Acute Achilles tendon rupture is a common injury with rising incidence. Open repair has traditionally been preferred but carries a notable risk of wound complications. Minimally invasive repairs reduce wound problems but often require costly proprietary kits, limiting accessibility in resource-constrained settings. We evaluated a spinal-needle-assisted percutaneous technique that uses standard hospital supplies and compared its outcomes with conventional open repair.

Methods: A prospective, randomized comparative study was conducted at a tertiary referral center in Northeast India between May 2023 and April 2025. Twenty-three patients with acute Achilles tendon rupture (<3 weeks) were randomized into open repair (n=10) or spinal-needle-assisted percutaneous repair (n=13). Functional outcomes were measured using the AOFAS Ankle-Hindfoot Score and VAS pain score at 3, 6, 9, and 12 months. Complication rates, time to full weight-bearing, and implant costs were analyzed.

Results: All repairs were completed successfully with no conversions.

• Surgical time: shorter in the percutaneous group (30 ± 5.2 min) vs open (50 ± 8.7 min) (p<0.001).
• Wound complications: 20% in open group vs 0% in percutaneous.
• Sural nerve injury: transient neuropraxia in 1 percutaneous case (7.7%), resolved by 9 months.
• Functional outcomes: At 12 months, AOFAS scores were 97.0 ± 2.3 (open) vs 99.1 ± 1.0 (percutaneous) (p=0.09), and VAS was 0 in both groups.
• Return to activity: By 6 months, 46% of percutaneous patients resumed recreational sports vs 30% of open repair patients.
• Cost savings: Percutaneous repair used only standard sutures and spinal needles (~INR 4, 000) versus commercial percutaneous kits (~INR 80, 000-100, 000), reducing implant costs by ~85-90%.

Conclusion: The spinal-needle-assisted percutaneous Achilles repair achieves functional outcomes comparable to open repair while reducing surgical morbidity, wound complications, operative time, and cost. This technique provides an accessible, low-cost alternative for acute Achilles tendon ruptures, particularly in resource-limited settings.

Level of Evidence: Level II — Prospective Comparative Study.