Percutaneous Achilles tendon repair using a simplified dual zig-zag technique with monofilament suture: A technical note and mid-term outcomes

Achilles tendon rupture (ATR) significantly impairs mobility and quality of life. Percutaneous repair offers minimal soft tissue trauma with satisfactory outcomes; however, many techniques require specialized tools and sutures, often unavailable in resource-limited settings. This study aimed to present a simplified dual zig-zag percutaneous repair technique using generic monofilament suture and report the mid-term outcomes. Patients with ATR treated at our institution between 2022 and 2024 who underwent a simplified percutaneous repair using a dual zig-zag configuration with monofilament sutures were included. Patient characteristics, cause of injury and timing, surgical duration, return to daily activities and sports, calf circumference differences, and complications were recorded retrospectively. The American Orthopaedic Foot & Ankle Society (AOFAS) score was used to evaluate functional outcome at 6-month follow-up. Ten patients (mean age, 31.0 ± 8.47 years) were included. All injuries were sport-related. The mean time from injury to surgery was 3.4 ± 1.43 days, with a surgical duration of 25.2 ± 5.19 minutes. All patients returned to daily activity within 6.5 ± 1.69 weeks and to recreational sports at 12.14 ± 1.46 weeks. Calf circumference difference between the affected and the healthy limb was -1.23 ± 1.43 cm. There were no re-ruptures, infections, or sural nerve injury. AOFAS score improved from 54.7 ± 11.52 preoperatively to 94.3 ± 3.69 ( P < 0.001) at final follow-up. This simplified percutaneous repair technique utilizing monofilament suture is simple, safe, and effective. It provides reliable tendon healing without requiring specialized instruments, making it particularly suitable for resource-limited settings.