For those that didn't see it, here's the exclusionary flow chart of the surgeries from 1958 - 2016
I count two studies (one with 95 cases, the other with 80, one of which Dr.Parekh was involved in) having a nearly identical average of a 72.5% return to sport rate-
"One previous study investigated RTS and postoperative performance for players who underwent Achilles tendon repair in the NFL. The prior study demonstrated an RTS of 72.5% in 80 NFL athletes. The RTS from this prior study is nearly identical to the results of the present study with an RTS of 72.4% in 95 NFL athletes."
"Following Achilles tendon repair, less than 75% of players returned to the NFL. Postoperative career length was 1 season shorter than matched controls. No difference was observed in the number of games per season played com-pared to matched controls. Postoperative performance scores were significantly worse for RBs and LBs compared to preoperative, and LBs had significantly worse postoperative performance when compared to matched controls."
and the very small PARS mini open study at 78%. I see a trend of some surgeons trying to move from open technique to a limited or mini-open technique (as opposed to a pure percutaneous repair).
“but the problem with a pure percutaneous solution is that you can’t see anything, so you can actually pierce the nerve.” The miniature-open technique requires only a 3 cm incision while the traditional approach of surgically treating Achilles tendon ruptures required an 8 cm to 12 cm incision.
“One of the biggest issues with the traditional model was long-term immobilization, and there was about an 8% to 10% chance of an infection or wound healing problem,” he notes. “The benefit of doing the mini-open technique is that your incisions are much smaller, so your wound complication rate postoperatively is under 1% or 0.5%."
This minimally invasive miniature-open technique is heavily dependent on special tools (PARS Achilles Jig System by Anthrex, Inc.: Naples, FL; Achillon Achilles Tendon Suture System by Integra LifeSciences Corp.: Plainsboro, NJ), and can add in costs up to $800 to 1,000 per use.
Dr. Selene G. Parekh, of Duke University, has pioneered a minimally invasive mini-open technique that does not use specialized equipment, and has adapted the miniature-open technique to require only standard operating room tools, such as surgical clamps and forceps, etc. to be able to grab the Achilles tendon and pass suture.
“You don't have to worry about a special instrument lining up properly in order to grab the tendon, so the whole procedure now takes about 20 to 30 minutes whereas traditionally it took 45 minutes to an hour,” he says.
While mini-open repair is available at Duke (and elsewhere), only Dr. Parekh is performing Achilles repair via this new technique without the need of special instruments. I'm interested to see what types of improved outcomes become apparent besides the time and cost savings up front.