Locating the Sural Nerve during Calcaneal (Achilles) Tendon Repair with Confidence: A Cadaveric Study with Clinical Applications

Abstract

The sural nerve is at risk of iatrogenic injury even during minimally invasive operative procedures to repair the calcaneal (Achilles) tendon. Through 107 cadaveric leg dissections, the data derived from the present study was used to develop a regression equation that will enable surgeons to estimate the intersection point at which the sural nerve crosses the lateral border of the Achilles tendon, an important surgical landmark. In most cases, the sural nerve crossed the lateral border of the Achilles tendon 8 to 10 cm proximal to the superior border of the calcaneal tuberosity. By simply measuring the leg length of the patient (from the base of the heel to the flexor crease of the popliteal fossa), surgeons can approximate the location of this intersection point with an interval length of 0.68 to 1.80 cm, with 90% confidence, or 0.82 to 2.15 cm, with 95% confidence. For example, for a patient with a lower leg length of 47.0 cm, the mean measurement in the present study, a surgeon can be 90% confident that the sural nerve will cross the lateral border of the Achilles tendon 8.28 to 8.96 cm (interval width of 0.68 cm) proximal to the calcaneal tuberosity. Currently, ultrasound and clinical techniques have been implemented to approximate the location of the sural nerve. The results of the present study offer surgeons another method, that is less intensive, to locate reliably and subsequently avoid damage to the sural nerve during calcaneal (Achilles) tendon repair and other procedures of the posterolateral leg and ankle.

Jigless knotless internal brace technique for acute Achilles tendon rupture: a case series study

“…A recent cadaver study reported that the sural nerve would crosses the lateral border of the Achilles tendon 8- to 10-cm proximal to the superior border of the calcaneal tuberosity in most cases [19]. Therefore, a surgeon can avoid injuring the sural nerve by doing all percutaneous procedures within 8 cm proximal to the calcaneal tuberosity.…”

Variations in sural nerve formation pattern and distribution on the dorsum of the foot

“…Its utility stems from the fact that it is easy to find and harvest due to its usual location in the superficial fascia and just posterior to the lateral malleolus in close association with the small saphenous vein. Moreover, the sural nerve is vulnerable to damage following fracture of related bones (Bae, 2013) or surgical procedures such as incision, retraction, and suture during reconstruction of the Achilles tendon (Citak et al, 2007;Blackmon et al, 2013;Lee and Park, 2014). It is also subjected to biopsy (Ruth et al, 2005) or nerve conducting studies for the diagnosis of diseases such as diabetic neuropathy (Kwon et al, 2000).…”

“…It is also subjected to biopsy (Ruth et al, 2005) or nerve conducting studies for the diagnosis of diseases such as diabetic neuropathy (Kwon et al, 2000). Moreover, the sural nerve is vulnerable to damage following fracture of related bones (Bae, 2013) or surgical procedures such as incision, retraction, and suture during reconstruction of the Achilles tendon (Citak et al, 2007;Blackmon et al, 2013;Lee and Park, 2014). Likewise, nerve entrapment occasionally occurs at the site (Pringle et al, 1974).…”

A Study of Sural Nerve Relationship With Tendoachilles in Human Cadavers

“…with Achilles Tendon and if any crossing of the nerve to medial side in relation to Achilles Tendon is of immense help for surgeons [9]. Accordingly, a view of previous studies at different level of Achilles Tendon in relation to Sural nerve along with observations made in the present study is assessed through following important parameters.…”