Abstract
BACKGROUND: The optimal management of acute Achilles tendon ruptures remains controversial. Open surgical repair (OSR) carries high complication rates, while minimally invasive techniques reduce risks but pose concerns regarding sural nerve injury. This study evaluates the clinical outcomes of ultrasound-assisted minimally invasive repair (MIR) using a double-ended shuttling needle. METHODS: A retrospective cohort of 41 patients (2017-2022) was analyzed: 19 underwent OSR (8-10 cm midline incision, Krackow suture), and 22 received MIR (2 cm incision, ultrasound-guided Bunnell suture with shuttling needle). Operative time, scar length, American Orthopaedic Foot & Ankle Society (AOFAS) score, Achilles Tendon Rupture Score (ATRS), calf circumference, and complications were compared. Statistical analyses included independent t-tests, Mann-Whitney U tests, and chi-square tests (α = 0.05). RESULTS: MIR demonstrated significantly shorter operative time (18.8 ± 3.0 min vs. 55.2 ± 6.5 min; p = 0.010) and smaller scars (2.02 ± 0.39 cm vs. 10.2 ± 1.9 cm; p = 0.005) versus OSR. No significant functional differences existed at 12 months (AOFAS: 90.2 ± 4.3 vs. 88.6 ± 3.8, p = 0.558; ATRS: 90.9 ± 3.3 vs. 89.7 ± 2.6, p = 0.601). Zero complications occurred with MIR, whereas the OSR had 1 superficial infection, 3 sural nerve injuries, and 2 cases of scar adhesion. MIR patients initiated controlled training at 3 months, showing superior trends in activity resumption. CONCLUSION: Ultrasound-assisted MIR reduces operative time by 69.9%, minimizes scarring by 80.2%, and eliminates nerve injury risks while achieving functional parity with OSR. Long-term biomechanical performance and resource accessibility warrant further investigation.