Anatomy of the sural nerve and its relation to the Achilles Tendon

Abstract

Sural nerve injury is a complication of Achilles Tendon (TA) rupture. We dissected 30 cadaveric lower limbs to describe the course of the sural nerve in relation to the TA. At the level of insertion of the TA into the calcaneum, the sural nerve was a mean 18.8 mm from the lateral border of the TA. The proximal course of the nerve was towards the midline such that it crossed the lateral border of the TA at a mean distance of 9.8 cm from the calcaneum. The significant individual variation in the position of the sural nerve in relation to the achilles tendon should be borne in mind when placing sutures in the proximal part of the achilles tendon. Percutaneous sutures should not be placed in the lateral half of the TA.

Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

“…After a mean follow-up of 4.8 years, most patients had no pain, were subjectively satisfied with the outcome, and had good or excellent results according to the anklehindfoot AOFAS score. These results compare favourably with those reported with both open and percutaneous endto-end suture [1,2,3,11,16,17,19]. Nyyssonen et al [13] retrospectively compared 39 repairs and 59 augmented reconstructions and found no differences in outcome.…”

“…Simple end-to-end suture is easier to perform and requires a less extensive dissection [16], but the poor quality of the tendon at the rupture site may compromise the strength of the repair. Surgical techniques have been developed to perform end-to-end suture of the Achilles tendon percutaneously [11,15,17,19], though the incidence of rerupture and sural nerve injury seems to be higher with percutaneous techniques [1,3,18]. On the contrary, augmented reconstruction provides a stronger repair that may allow a more aggressive rehabilitation program and reduce the incidence of rerupture.…”

“…There were more reruptures in the conservative group, but infection complicated two of the surgically treated patients [12]. However, at the present time, many authors favour operative treatment for acute ruptures of the Achilles tendon [2,9,10,17,19,22].…”

“…However, several recent reports have favoured operative treatment in order to allow a faster recovery and minimize the rerupture rate. Surgical techniques include simple end-to-end suture [1,2,16,17,19] and several procedures for augmented reconstruction. [5,13,22] Augmented reconstruction, initially developed for chronic or neglected ruptures, is now also used for acute ruptures by some authors [22].…”

Minimally invasive plate osteosynthesis of distal tibial fracture using a posterolateral approach: a cadaveric study and preliminary report

“…Therefore, the risk of injury of these neurovascular structures is greater at the distal end than at the proximal end of the distal incision. In addition, previous studies found considerable variation in anatomy of the SN [21,22], and it is essential if using this surgical approach that the surgeon be cautious with the dissection to avoid injury to this nerve.…”