Skip to main content

Advertisement

SpringerLink
Log in

Dynamic percutaneous repair of the ruptured tendo Achillis

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

We have modified the traditional percutaneous repair of the ruptured tendo Achillis so to obtain a lower rate of complications than in open repair, a low rate of re-rupture and an early mobilization and return to full weight bearing and sport activities especially in professional sportsmen. We reviewed 80 patients (52 men and 28 women), 10 of which were professional athletes. We have named this technique “dynamic percutaneous suture” (DPS). The repair was carried out using 10 micro-incisions, 5 laterals and 5 medial to the posterior aspects of the tendon with absorbable suture. We used one suture through the four proximal incisions in an 8-shaped and one suture through the four distal as well. The patients were assessed according to the criteria established by the clinical AOFAS rating score. No re-rupture or sural nerve damages were observed. In all the treated patients, the results obtained were rated from good to excellent. One patient had mild disturbances of sensibility over the lateral heels (completely resolved in 2 months), and two patients had scar adhesions. The absorbable suture permits what we call a “dynamic” healing of the tendon, through an “elastic” fixation of the two stumps, as in the healing of a fractured long bone treated with a dynamic nail fixation. We so obtained a short immobilization time and an early full motion and weight bearing. Return to sport activities was permitted in 8–12 weeks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Anderson E, Hvass I (1986) Suture of Achilles Tendon under local anesthesia. Acta Orthop Scand 57:235–236

    Article  Google Scholar 

  2. Beskin JL, Sanders RA, Hunter SC et al (1987) Surgical repair of Achilles tendon ruptures. Am J Sports Med 15(1):1–8

    Article  PubMed  CAS  Google Scholar 

  3. Carden DG, Noble J, Chalmers J et al (1987) Rupture of the calcaneal tendon: the early and late menagment. J Bone Joint Surg 69B(3):416–420

    Google Scholar 

  4. Inglis AE, Scott WN, Sculco TP et al (1976) Ruptures of the tendo achillis: an objective assessment of surgical and non surgical treatment. J Bone Joint Surg 58-A:990–993

    Google Scholar 

  5. Cetti R, Christiansen SE, Ejest R et al (1993) Operative versus non operative treatment of Achilles Tendon rupture. Am J Sports Med 21:791–799

    Article  PubMed  CAS  Google Scholar 

  6. Chiodo CP, Wilson MG (2006) Current concepts review: acute ruptures of the Achilles tendon. Foot Ankle Int 27:305–313

    PubMed  Google Scholar 

  7. Edna T (1980) Nonoperative tretment of Achilles tendon ruptures. Acta Orthop Scand 51:991–993

    Article  PubMed  CAS  Google Scholar 

  8. Keller J, Rasmussen TB (1972) Nonsurgical treatment of Achilles tendon rupture. J Bone Joint Surg 54A:1398–1407

    Google Scholar 

  9. Nistor L (1981) Surgical and nonsurgical treatment of Achilles tendon ruptures. J Bone Joint Surg 63A:394–399

    Google Scholar 

  10. Willis CA, Washburn S, Ciaozzo V et al (1986) Achilles tendon rupture: a review of the letterature comparing surgical versus nonsurgical treatment. Clin Orthop Res 207:156–163

    Google Scholar 

  11. Ma GW, Griffith TG (1977) Percutaneous repair of acute closed ruptured Achilles tendon: a new technique. Clin Orthop Relat Res 128:247–255

    PubMed  Google Scholar 

  12. Buchgrabber A, Passler HH (1997) Percutaneous repair of Achilles tendon rupture. Immobilization versus functional postoperative treatment. Clin Orthop 341:113–122

    Google Scholar 

  13. Delponte P, Potier L, de Poulpiquet P et al (1992) Tretment of subcutaneous ruptures of the Achillis tendon by percutaneous tenorraphy. Rev Chir Orthop 78:404–407

    PubMed  CAS  Google Scholar 

  14. Gorschewsky O, Vogel U, Schweizer A et al (1999) Percutaneous tenodesis of the Achilles tendon. A new surgical method for treatment of acute Achilles tendon rupture through percutaneous tenodesis. Injury 30(5):315–321

    Article  PubMed  CAS  Google Scholar 

  15. Webb JW, Bannister GC (1999) Percutaneous repair of the ruptured tendo Achilles. J Bone Joint Surg (Br) 81B(5):877–880

    Article  Google Scholar 

  16. Assal M, Jung M, Stern R et al (2002) Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am 84:161–170

    PubMed  Google Scholar 

  17. Cretnik A, Kosanovic M, Smrkolj V (2004) Percutaneous suturing of ruptured Achilles tendon under anesthesia. J Foot Ankle Surg 43:72–81

    Article  PubMed  Google Scholar 

  18. Gorschewsky O, Pitzl M, Putz A et al (2004) Percutaneous repair of acute Achilles tendon rupture. Foot Ankle Int 25:219–224

    PubMed  Google Scholar 

  19. Webb J, Moorjani N, Radford M (2000) Anatomy of the sural nerve and its relation to Achilles Tendon. Foot Ankle Int 21:475–477

    PubMed  CAS  Google Scholar 

  20. Lawrencw SJ, Botte M (1994) The sural nerve in the foot and ankle: an anatomical study with clinical and surgical implications. Foot Ankle Int 15(9):490–494

    Google Scholar 

  21. Kitaoka H, Alexander I, Adelaar R (1994) Clinical rating system for the ankle, hindfoot, hallux and lesser toes. Foot Ankle Int 15:349–353

    PubMed  CAS  Google Scholar 

  22. Majewsky M, Rohrbach M, Czaja S, Ochsner P (2006) Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med 34:793–798

    Article  Google Scholar 

  23. Sato M, Maeda M, Kurosawa H et al (2000) Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies. J Orthop Sci 5(3):256–267

    Article  PubMed  CAS  Google Scholar 

  24. Wada A, Kubota H, Akiyama T et al (2001) Effect of absorbable polydioxanone flexor tendon repair and restricted active mobilization in a canine model. J Hand Surg 26(3):398–406

    Article  CAS  Google Scholar 

Download references

Conflict of interest

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics Surgery, Ospedale Civile Nuovo Santa Maria della Scaletta, Via Montericco 4, 40026, Imola (Bo), Italy

    L. Gaiani, R. Bertelli & M. Palmonari

  2. Divisione Ortopedia e Traumatologia, Ospedale Civile Nuovo Santa Maria della Scaletta, Via Montericco 4, 40026, Imola, (Bo), Italy

    M. Palmonari

Authors
  1. L. Gaiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Bertelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Palmonari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Palmonari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gaiani, L., Bertelli, R. & Palmonari, M. Dynamic percutaneous repair of the ruptured tendo Achillis. Eur J Orthop Surg Traumatol 22, 709–712 (2012). https://doi.org/10.1007/s00590-011-0897-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-011-0897-4

Keywords

Search

Navigation