J Korean Orthop Assoc.  2009 Dec;44(6):661-667. 10.4055/jkoa.2009.44.6.661.

Percutaneous Repair of Acute Achilles Tendon Ruptures

• Jeon TS
• Kim SB
• Jung WY
• Heo YM
• Park CY

• KMID: 2186293
• DOI: http://doi.org/10.4055/jkoa.2009.44.6.661

Abstract

PURPOSE
The purpose of the present study was to evaluate and analyze the clinical outcomes of the percutaneous repair of acute achilles tendon ruptures.
MATERIALS AND METHODS
We performed a retrospective study on 14 patients with acute closed rupture of the Achilles tendon and they were managed with percutaneous repair from Jan. 2006 to Jun. 2007. The clinical outcomes were analyzed according to the causes of the injury and the postoperative functional performances.
RESULTS
All the cases showed good or excellent outcomes, according to the Arner-Lindholm scale for the evaluation of acute Achilles tendon rupture. The average AOFAS score was 95.6 (range: 91-100). Nine patients were very satisfied and five patients were satisfied. They were satisfied especially because of the minimal postoperative scar. Two cases of sural nerve injury were reported as complications, and these cases fully recovered at postoperative three months. No evidence of surgical wound infection, necrosis of the wound or rerupture of the tendon was seen.
CONCLUSION
The percutaneous repair of acute Achilles tendon rupture achieved high functional outcomes, a successful return to previous work and high satisfaction, with a relatively low incidence of complications.

Keyword

Achilles tendon; Acute rupture; Percutaneous repair

MeSH Terms

Achilles Tendon
Cicatrix
Humans
Incidence
Necrosis
Organic Chemicals
Retrospective Studies
Rupture
Sural Nerve
Surgical Wound Infection
Tendons
Organic Chemicals

Figure

• 

  Fig. 1 (A-G) The procedure was started and finished medially and distally. First, a suture on a long, a needle was transversely passed through the tendon (A), followed by a (diagonal) cross-suture (B). At each site of the first needle entrance or exit, the incision was widened in a longitudinal direction with a No. 11 blade over the inserted needle to enable the surgeon to bury the suture subcutaneously (on the paratenon) when threading the suture through the same hole (B). A small hemostat could also be used to widen the hole and facilitate burying the suture. The thread was then led longitudinally, subcutaneously, and extratendinously (C), and the next cross through the tendon was done proximally. Next, both thread ends were led extratendinously back through the second and third holes distally (D) and pulled symmetrically back until both ends of the torn Achilles tendon were completely approximated and the defect was no longer palpable (D). After approximating the torn Achilles tendon ends, the lateral end of the thread was passed medially (E), and after final simultaneous tightening of both ends of the thread, the suture was tied (Fig. F). The knots were buried subcutaneously in the previously widened second medial stab incision (F). Immediate postoperative gross feature (G).

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  Fig. 2 The same patient as in Fig. 1. Postoperative function: The patient can walk normally and lift the affected heel as efficiently as the unaffected heel 6 months after surgery.

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