Percutaneous Repair of Acute Achilles Tendon Rupture

Abstract

Various studies have shown that the operative treatment of a freshly ruptured Achilles tendon is generally considered to be more appropriate than a nonoperative regimen. However, complications in open reconstructions are reported to occur in 11-29%. The method used in this study reduced the risk of complications arising from operation, but simultaneously allowed early postoperative mobilization and functional treatment. It was a percutaneous repair of the Achilles tendon, using two Lengemann extension wires for coadaptation of the ruptured tendon. To fix the rupture site, the authors used a fibrin sealant. The spikes of the wire were hooked in at the fascia of the soleus muscle. Via a big, curved needle, the wire was placed in the distal stumps of the ruptured tendon and guided out laterally and medially above the calcaneus. After blocking the wires distally, the fibrin sealant was applied at the rupture site. The current report describes this method of treatment in 66 patients. The postoperative observation period was 1 year. Sixty-four patients were male and two were female. Their average age was 42 years. The Achilles tendon ruptures occurred during sporting activities and were treated by operation within 22 hours on average. The outcome was very good in 98%. One patient (2%) suffered a rerupture due to trauma. There were no other complications.

Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?

“…Lim et al [20] described a 3% rerupture rate, Haji et al [13] a 2.6% rate, and Amlang et al [3] a 3.2% rate. In contrast to these findings, we found no reruptures in our percutaneous repair group, and for the open group, our finding is similar to that reported in the literature [8,10,12]. Another of the most described complications for the percutaneous approach is sural nerve injury [13,20,21,23].…”

“…Faster recovery after surgery could be explained by the lesser amount of soft tissue affected by the percutaneous repair. Similar observations have been reported for percutaneous repair [1,9,11,12]. Gorschewsky et al [12] reported satisfactory function in 66 patients with percutaneous repair, with similar values of muscle strength and ROM for left and right ankles in 65 patents.…”

“…Percutaneous repair reportedly has a low rate of complications and a high grade of satisfaction [12,20]. Percutaneously repaired Achilles tendons are less thick than those repaired with open procedures, often with better cosmesis.…”

Achilles Tendon Repair Under Local Anesthesia

“…There are many percutaneous closed (Čretnik et al, 2000Gorschewsky et al, 2004;Ma & Griffith, 1977;Majewsky et al, 2006;Webb & Bannister, 1999) and semi-open methods (Amlang et al, 2006;Assal et al, 2002;Kakiuchi, 1995) proposed. They are four or six stab -incision techniques with one-aside pulling technique and consequently arose problem with non or malaligned stumps (so called fish-tail phenomenon) (Hockenbury & Johns, 1990)).…”

Die Bassi-Methode: eine modifizierte Lappentechnik als Alternative zur offenen Achillessehnennaht

“…Obwohl die Inzidenz chirurgischer Komplikationen seit Jahren abnimmt [16,17], führen postoperative Komplikationen wie Infektion, Wunddehiszenz, Schorfbildung und Narbenadhäsionen sehr oft zu schlechteren Ergebnissen [3,7,8,11,17]. Daher wurde die perkutane Technik eine beliebte Alternative zur offenen Technik [4,15]. Komplikationen wie Verletzung des Nervus suralis, tastbare Nahtknoten und Rerupturen können jedoch auch bei dieser Methode zu Einschränkungen der Sprunggelenkfunktion führen [2,5].…”