Introduction/Purpose: Achilles tendon ruptures remain the most common tendon injury within the lower extremity. While the incidence continues to rise, changing immobilization protocols, techniques, and surgeon preferences have evolved over the past few decades. The purpose of this study was to characterize the complication rate in acute Achilles tendon repair by surgeon volume and location in a heterogenous major metropolitan area.
Methods: Achilles tendon repairs (CPT27650) performed from January 2018 through December 2022 with a minimum two-month follow-up were retrospectively reviewed. Patients were excluded if they had chronic tears that required reconstruction, underwent a revision repair/reconstruction, or were initially treated nonoperatively. 1035 Achilles tendon ruptures met inclusion criteria. The primary outcome measure was total complication rate by surgeon volume. High volume surgeons were defined as if the surgeon completed 30 or more repairs within the five-year study period. Low volume surgeons performed 29 or less repairs over the same period. Major complication rate (reoperation, deep infection, tendon re-rupture, and loss of Achilles tension requiring re-operation) and minor complication rate (sural neuritis, superficial infection, delayed wound healing, heel pain, and loss of Achilles tension not requiring re-operation) were also documented by surgeon volume. Complication rates by geographic location of practice (Urban vs. Suburban) were recorded. Descriptive statistics and multivariate regression were utilized.
Results: The overall complication rate was 15.8%—with 3% (N=31) having major complications. Patients were significantly less likely to encounter any complication (p=.017) or minor complication (p=.0091) with surgeons who performed 30 or more Achilles repairs over a five-year period. There was no difference in major complication rate (p>0.999) or re-operation rate (p=0.7337) between high and low volume surgeons. Urban-based practices experienced improved minor (p=0.031) and overall complication rates (p=0.0177) compared to suburban-based practices. There was no difference in major complication rate (p=0.3967).
Conclusion: In this large community cohort, patients electing to have an acute, midsubstance Achilles tendon repair experienced fewer overall complications with high volume and urban-based surgeons. There was no difference in re-operation rate between high and low volume surgeons.
AbstractFirst published online January, 2026