Die perkutane Naht der Achillessehne mit dem Dresdner Instrument

Abstract

From January 1, 2000 to December 31, 2003, 61 patients with 62 Achilles tendon ruptures were sutured using the percutaneous technique with the Dresden Instrument. No sural nerve lesions and only two reruptures (3.2%) were observed. In one patient (1.6%) a superficial late infection occurred after 8 weeks, when the tendon was already healed. Of 47 patients with a follow-up time of at least 1 year, 39 with 40 Achilles tendon ruptures were followed up (83%). According to the criteria of Trillat & Mounier-Kuhn, the result was very good in 62% and good in 30%. On the AOFAS Score, an average of 96 points (78-100 points) was achieved. 78% of the patients assessed the result of the treatment as very good and 20% as good.

Ultrasonographic Classification of Achilles Tendon Ruptures as a Rationale for Individual Treatment Selection

“…The position of 20° plantar flexion of the foot corresponds to the position of the ankle joint, in which protection of the healing tendon in the first 6 weeks may occur [8, 13, 16]. If the contact of the tendon ends is inadequate from the start, it cannot be expected that under nonoperative therapy this will spontaneously improve.…”

“…In the elder rupture of the Achilles tendon, a simple rearrangement of the contact of the tendon ends is not sufficient, since the tendon ends are no longer able to regenerate and a shortening of the triceps surae is present (Figure 5). In contrast, a fresh rupture of the Achilles tendon with good contact of the tendon ends either with nonoperative-functional therapy or after minimal invasive suture immigrating of fibroblasts can occur with resulting collagen formation, thereby establishing a homogeneous tendon in the context of extrinsic tendon healing [8, 16]. …”

“…Upon patient request or in the case of noncompliance, the percutaneous suture with the Dresden instrument (pDI suture) was utilized in this classification of injury. The pDI suture is a minimal invasive, closed, subfascial surgical technique which preserves the peritendon and minimizes the risks of other minimally invasive techniques such as injury to the Sural nerve or worsening of the contact of the tendon ends by the suture [8]. …”

“…Even with incidence of this tendinosis of the insertion in a fresh, distal rupture, good experiences were seen with the transcalcaneal pDI suture technique [8]. In patients with an elder type 5 rupture using our own procedure, the replacement of the degenerated, distal Achilles tendon by a Flexor Hallucis Longus transfer worked satisfactorily with the aim of a functional reestablishment of the patient's plantarflexory abilities [18].…”

“…However, it appeared that due to the variable morphology of the rupture location a definition of the exact measuring points was possible but became very difficult to obtain reliable data. The experiences with the sonographic evaluation of the healing process after nonoperative-functional therapy, independent reexaminations, and the development of a minimally invasive suture technique were reasons for the development of an ultrasonic classification of the rupture of Achilles tendon, leading to a guideline for using a nonoperative-functional procedure [8, 9]. …”