Minimally Invasive Percutaneous Achilles Repair System (PARS) Repair With vs Without Bio-inductive Scaffold Augmentation for Acute Achilles Tendon Rupture: A Retrospective Comparative Cohort Study.

BACKGROUND: Acute Achilles tendon rupture is a common injury in active individuals, often requiring surgical repair to reduce re-rupture rates, restore appropriate tendon length and plantarflexion power, and optimize functional recovery and return to sport (RTS). Bio-inductive collagen scaffolds have been introduced to enhance tendon healing; however, their role in acute rupture remains unclear. METHODS: A retrospective comparative cohort study was conducted including 30 patients (30 tendons) treated between 2021 and 2024 with minimally invasive percutaneous Achilles repair system (PARS) repair, with (n = 15) or without (n = 15) bio-inductive scaffold augmentation. All patients underwent surgery within 2 weeks of injury. The primary outcome was Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF). Secondary outcomes included PROMIS pain interference (PI), RTS, and complication rates. PROMIS PF and PI scores were collected using validated electronic computer-adaptive questionnaires preoperatively and at 3, 6, 12, and 18 months, postoperatively. RESULTS: Baseline characteristics were comparable between groups. RTS was achieved in 87% of scaffold patients and 80% of controls (P = .64). Time to RTS was shorter in the scaffold group (8.4 ± 1.3 vs 10.1 ± 1.6 months; P = .002). PROMIS PF was higher in the scaffold group at 3 months (52.1 ± 5.6 vs 47.3 ± 6.1; P = .02) and 6 months (56.8 ± 5.2 vs 52.4 ± 5.9; P = .03), with similar findings for PROMIS PI (P < .05). Outcomes converged at 12 and 18 months (all P > .40). Complication rates were low and comparable (13% vs 20%; P > .99). CONCLUSION: Bio-inductive scaffold augmentation in minimally invasive Achilles tendon repair was associated with improved early functional outcomes and shorter time to return to sport, with no significant difference in complications between groups. These secondary outcomes were not independently powered and should be interpreted with caution. Further prospective randomized studies are warranted. LEVEL OF EVIDENCE: Level III, retrospective cohort study.