J Korean Orthop Assoc.  2018 Dec;53(6):522-529. 10.4055/jkoa.2018.53.6.522.

Intraoperative Ultrasound-Guided Percutaneous Repair of a Ruptured Achilles Tendon: A Comparative Study with Open Repair

• Kang DH
• Kang C
• Hwang DS
• Song JH
• Choi BS

• KMID: 2430059
• DOI: http://doi.org/10.4055/jkoa.2018.53.6.522

Abstract

PURPOSE
To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon.
MATERIALS AND METHODS
The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated.
RESULTS
The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p < 0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B.
CONCLUSION
USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.

Keyword

achilles tendon; ultrasound; percutaneous repair; sural nerve; absorbable suture material

MeSH Terms

Achilles Tendon*
Ankle
Cicatrix
Foot
Heel
Humans
Orthopedics
Retrospective Studies
Rupture
Sural Nerve
Ultrasonography

Figure

• 

  Figure 1 Illustration of the modified Kessler's suture technique in the ultrasound-guided percutaneous repair group. The procedure starts from distalolateral portion of the Achilles tendon and returns to the start point clockwise. This is repeated two times. Black dotted line: first modified Kessler's suture; Full line: second suture.

• 

  Figure 2 (A) Surgical scene of intraoperative ultrasound-guided percutaneous repair of the left Achilles tendon. Axial ultrasound scan, which indicates sural nerve lateral to the lesser saphenous vein and Achilles tendon at the distal portion (B), mid portion (C), proximal portion (D). These show that the sural nerve becomes closer to Achilles tendon as the probe is moved from the distal to proximal portion. Arrow and dotted ellipse: sural nerve; Asterisk ellipse: lesser saphenous vein; Triangle ellipse: Achilles tendon.

• 

  Figure 3 (A–H) Surgical procedures of intraoperative ultrasound-guided percutaneous repair of the left Achilles tendon. The modified Kessler's suture is started from the distalolateral portion of the Achilles tendon and returns to the start point clockwise. (I) Ruptured Achilles tendon was over-corrected about 10° compared to opposite ankle in consideration of early elongation. This was repeated twice.

• 

  Figure 4 This figure shows that the needle penetrates the suture material (Vicryl). Special attention is needed to prevent this.

• 

  Figure 5 Surgical site scars at the last postoperative follow-up in both groups: (A) Scar in the ultrasound-guided percutaneous repair group. (B) Scar in the open repair group. The mean length of the incision was 5.7 cm. Data from the article of Kang et al. (J Korean Foot Ankle Soc. 2014;18:115-8).9)

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