In percutaneous surgery to repair a ruptured achilles tendon, several small incisions are made in your lower leg instead of one large incision. Percutaneous surgery, while less invasive than open surgery, can also cause some unexpected problems.

Advantages of percutaneous repair over open surgery for achilles injuries include:

• Significantly less expensive.
• Shorter surgery time.
• Less damage to growth factors and blood clots around ruptured ends of the achilles tendon.
• Less cosmetic scarring.
• Lesser risk of infection.

Disadvantages of percutaneous repair over open surgery include:

• Hard to visualize if the two ends of the ruptured tendon have been exactly connected to each other (i.e., also referred to as “coaption” or “apposition”). It should be noted that the use of intra-operative ultrasound as well as endoscopy in the hands of an experienced surgeon nowadays makes error rates in tendon apposition negligible.
• Chances of damaging sural nerve higher.
• According to some studies, complete tendon gap closure after percutaneous repair takes several weeks longer than after open surgery.

— Some interesting videos of Arthrex’s PARS  surgery.

— A 2017 article from ESPN suggested that “mini-open repair” surgery is superior to traditional open surgery to repair an achilles tendon.