SYSTEMATIC REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1671249
Minimally Invasive versus Open Surgery for Acute Achilles Tendon Rupture: An Umbrella Review of Systematic Reviews and Meta-Analyses
Provisionally accepted
- 1Majmaah University, Al Majma'ah, Saudi Arabia
- 2Qassim University Department of Orthopedic Surgery, Buraydah, Saudi Arabia
- 3Qassim University Unaizah College of Medicine and Medical Sciences, Unayzah, Saudi Arabia
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Background: Achilles tendon rupture is a common injury requiring surgical intervention. The choice between Minimally Invasive Surgery (MIS) and Open Surgery (OS) has been widely debated. This umbrella review synthesized the results of systematic reviews and meta-analyses comparing outcomes of MIS and OS for acute Achilles tendon rupture. Methods: A comprehensive search was conducted using PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The AMSTAR-2 checklist was employed to assess the quality of the included systematic reviews and meta-analyses. Data on complication rates, surgical times, functional outcomes, and other patient-centric metrics were extracted and analyzed. Results: An aggregate of 6,480 participants were drawn from 7 included studies (not de-duplicated across overlapping trials). The primary outcomes were re-rupture and validated functional recovery scores; key complications included infection and sural nerve injury; secondary endpoints included operative time and return-to-sport. Searches, selection, and extraction followed prespecified criteria. Because the unit of analysis was published evidence syntheses and the underlying randomized trials overlapped with heterogeneous outcome definitions, results were synthesized qualitatively rather than pooled quantitatively. Across reviews, minimally invasive and open repair showed broadly comparable clinical effectiveness, with differences contingent on technique, perioperative protocols, and follow-up windows. Conclusion: MIS appears to offer significant advantages over OS for the repair of acute Achilles tendon ruptures, including reduced complication rates and faster recovery times, without compromising the effectiveness of the repair in preventing re-ruptures. However, the potential for nerve injury with MIS warrants careful consideration. Decisions regarding surgical techniques should be tailored to individual patient circumstances and the specific expertise of the surgical team.
Keywords: Achilles tendon rupture, minimally invasive surgery, Open surgery, Systematic review, Meta-analysis, surgical outcomes
Received: 22 Jul 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Albaker, Alshahrani and Almogbil. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Abdulmalik B Albaker, abdulmalikalbaker615@yahoo.com
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