Reversed Tendon Sheath Wrapping on Indirect Rupture of Tendo Calcaneus

Chung, Duke Whan; Yim, Chang Moo

Abstract

In the operative treatment of an indirect rupture of tendo calcaneus, we should consider difficult repair and postoperative adhesion with surrounding tissues. In this paper, the new surgical technique for indirectly ruptured tendo calcaneus was introduced and evaluated. From July 1994 to Sep. 1995, we experienced 10 cases of closed rupture of Achilles tendon which was treated with reversed tendon sheath wrapping of juncture site after direct repair. This technique consists of conventional core suture with strong suture material followed by fine tide up sutures around the ragged outer margin of the ruptured end. Then, we made a delicate incision on the synovial sheath of the tendon two inch proximal to the tendon juncture site and elevated it carefully and rolled it back reverse direction to wrap around the juncture site, then hooked it up with the synovial sheath of distal part of ruptured tendon. It was very helpful to prevent adhesion by lowering the endotendon cellular ingrowth between tendon proper and tendon sheath by wrapping the ragged end of rupture site. Their least follow-up period was 12 months. The clinical outcome of the patients was assessed according to the criteria of Hooker, and there were eight cases of excellent (80%), and two cases of satisfactory results. We report good results with the reversed tendon sheath wrapping around juncture site after direct repair of Achilles tendon, as a new technique the treatment of indirectly ruptured tendo calcaneus.