ArticlePloS one2025
Comparison of outcomes between minimally invasive percutaneous bunnell suture and traditional open modified Kessler technique for acute closed achilles tendon rupture: A single-center cohort study.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Percutaneous Bunnell repair and open modified Kessler repair remain debated options for acute Achilles tendon rupture (AATR). We retrospectively compared a minimally invasive percutaneous Bunnell technique (Group A) with an open modified Kessler repair (Group B) within a standardized early functional rehabilitation (EFR) protocol at a single center. Fifty-five adults with closed AATR treated between January 2021 and December 2022 were analyzed (Group A, n = 25; Group B, n = 30). Between-group comparisons used Welch t tests for continuous variables and χ² or Fisher exact tests for categorical variables; American Orthopaedic Foot & Ankle Society (AOFAS) and Achilles Tendon Total Rupture Score (ATRS) were assessed at 12 and 24 weeks, with Holm adjustment applied within each scale. Compared with Group B, Group A had shorter operative time (56.6 ± 15.1 vs 68.2 ± 23.2 minutes; mean difference -11.6; 95% CI -22.05 to -1.15; P = 0.030), less intraoperative blood loss (28.4 ± 8.4 vs 74.7 ± 19.4 mL; -46.3; 95% CI -54.22 to -38.38; P < 0.001), and a shorter length of stay (4.8 ± 2.0 vs 6.6 ± 2.9 days; -1.8; 95% CI -3.13 to -0.47; P = 0.009). At 12 weeks, AOFAS favored Group A (+1.36; 95% CI + 0.19 to +2.53; P = 0.047) and ATRS also favored Group A (+1.73; 95% CI + 0.48 to +2.98; P = 0.008). At 24 weeks, AOFAS was not different (+0.51; 95% CI -0.49 to +1.51; P = 0.312), whereas ATRS remained higher in Group A (+2.17; 95% CI + 0.88 to +3.46; P = 0.003). Overall complications were 12.0% vs 26.7% (risk difference -14.7%; 95% CI -34.10 to +7.20; P = 0.310); no sural nerve injuries occurred. Within an EFR framework, percutaneous Bunnell repair provided superior perioperative efficiency with comparable safety and modest, sub-MCID functional advantages, supporting confirmation in larger prospective studies.
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