{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:29:37Z","timestamp":1765823377088,"version":"3.48.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82202682"],"award-info":[{"award-number":["82202682"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Hebei Province Government-funded Training Program for Clinical Medical Professionals","award":["ZF2025138"],"award-info":[{"award-number":["ZF2025138"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Percutaneous Bunnell repair and open modified Kessler repair remain debated options for acute Achilles tendon rupture (AATR). We retrospectively compared a minimally invasive percutaneous Bunnell technique (Group A) with an open modified Kessler repair (Group B) within a standardized early functional rehabilitation (EFR) protocol at a single center. Fifty-five adults with closed AATR treated between January 2021 and December 2022 were analyzed (Group A, n\u2009=\u200925; Group B, n\u2009=\u200930). Between-group comparisons used Welch t tests for continuous variables and \u03c7\u00b2 or Fisher exact tests for categorical variables; American Orthopaedic Foot &amp; Ankle Society (AOFAS) and Achilles Tendon Total Rupture Score (ATRS) were assessed at 12 and 24 weeks, with Holm adjustment applied within each scale. Compared with Group B, Group A had shorter operative time (56.6\u2009\u00b1\u200915.1 vs 68.2\u2009\u00b1\u200923.2 minutes; mean difference \u221211.6; 95% CI \u221222.05 to \u22121.15; P\u2009=\u20090.030), less intraoperative blood loss (28.4\u2009\u00b1\u20098.4 vs 74.7\u2009\u00b1\u200919.4 mL; \u221246.3; 95% CI \u221254.22 to \u221238.38; P\u2009&lt;\u20090.001), and a shorter length of stay (4.8\u2009\u00b1\u20092.0 vs 6.6\u2009\u00b1\u20092.9 days; \u22121.8; 95% CI \u22123.13 to \u22120.47; P\u2009=\u20090.009). At 12 weeks, AOFAS favored Group A (+1.36; 95% CI\u2009+\u20090.19 to +2.53; P\u2009=\u20090.047) and ATRS also favored Group A (+1.73; 95% CI\u2009+\u20090.48 to +2.98; P\u2009=\u20090.008). At 24 weeks, AOFAS was not different (+0.51; 95% CI \u22120.49 to +1.51; P\u2009=\u20090.312), whereas ATRS remained higher in Group A (+2.17; 95% CI\u2009+\u20090.88 to +3.46; P\u2009=\u20090.003). Overall complications were 12.0% vs 26.7% (risk difference \u221214.7%; 95% CI \u221234.10 to +7.20; P\u2009=\u20090.310); no sural nerve injuries occurred. Within an EFR framework, percutaneous Bunnell repair provided superior perioperative efficiency with comparable safety and modest, sub-MCID functional advantages, supporting confirmation in larger prospective studies.<\/jats:p>","DOI":"10.1371\/journal.pone.0339026","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:21:56Z","timestamp":1765822916000},"page":"e0339026","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of outcomes between minimally invasive percutaneous bunnell suture and traditional open modified Kessler technique for acute closed achilles tendon rupture: A single-center cohort study"],"prefix":"10.1371","volume":"20","author":[{"given":"Zihang","family":"Zhao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyong","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianxin","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-8988","authenticated-orcid":true,"given":"Ruipeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"issue":"3","key":"pone.0339026.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2024-001960","article-title":"Acute Achilles tendon ruptures between 2002-2021: sustained increased incidence, surgical decline and prolonged delay to surgery-a nationwide study of 53 688 ruptures in Sweden","volume":"10","author":"S Svedman","year":"2024","journal-title":"BMJ Open Sport Exerc Med"},{"issue":"6","key":"pone.0339026.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0304197","article-title":"Incidence, demographics, characteristics and management of acute Achilles tendon rupture: An epidemiological study","volume":"19","author":"S Briggs-Price","year":"2024","journal-title":"PLoS One"},{"key":"pone.0339026.ref003","doi-asserted-by":"crossref","first-page":"1483584","DOI":"10.3389\/fsurg.2024.1483584","article-title":"Surgical vs. nonoperative treatment for acute Achilles\u2019 tendon rupture: a meta-analysis of randomized controlled trials","volume":"11","author":"L Fan","year":"2024","journal-title":"Front Surg"},{"key":"pone.0339026.ref004","doi-asserted-by":"crossref","first-page":"101769","DOI":"10.1016\/j.foot.2020.101769","article-title":"Long-term follow-up after acute achilles tendon rupture - Does treatment strategy influence functional outcomes?","volume":"47","author":"L Nilsson","year":"2021","journal-title":"Foot (Edinb)"},{"issue":"15","key":"pone.0339026.ref005","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1056\/NEJMoa2108447","article-title":"Nonoperative or Surgical Treatment of Acute Achilles\u2019 Tendon Rupture","volume":"386","author":"SB Myhrvold","year":"2022","journal-title":"N Engl J Med"},{"issue":"9","key":"pone.0339026.ref006","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.3390\/medicina60091382","article-title":"Open vs. Percutaneous Achilles Tendon Repair: Experience of Single Orthopedic Institute with Long-Term Follow-Up","volume":"60","author":"G Caruso","year":"2024","journal-title":"Medicina (Kaunas)"},{"issue":"5","key":"pone.0339026.ref007","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.fas.2019.07.011","article-title":"Outcomes of open \u201ccrown\u201d type v. percutaneous Bunnell type repair of acute Achilles tendon ruptures. 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