Abstract
The management of acute Achilles tendon ruptures is still controversy. Some current recommendations are in support of the surgical option with early rehabilitation. The percutaneous technique is a compromise between the conservative treatment and the open surgery. It allows a correct connection of the tendon ends with a lower skin and infection complications. According to some studies, reruptures and sural nerve injuries rates are still significant with the percutaneous technique. We tried to find a way to improve the percutaneous option. The subcutaneous position of the tendon makes its ultrasonographic exploration easy. The ultrasonography seemed to represent a non-invasive tool for guiding the percutaneous tenorraphy. The aim of our study is the evaluation of the intra-operative ultrasonography in the Achilles tendon percutaneous technique. We compared two groups according to the percutaneous tenorraphy and early rehabilitation. The first group (group A, 21 patients) was ultrasound-controlled during the operation, and the second one (group B, 12 patients) without control. The mean follow-up in the group A was 12 months and 24.5 months in the second group. In the ultrasonography group, we did not find neither general complication, neither iterative rupture nor sural nerve injury. The return to work was observed earlier in the group A at 45 days. There was no significant difference between skin necrosis, return to sport, plantar flexion strength and calf muscle atrophy. The economic impact was considered lower by patients in the group A. The ultrasonography contribution is certain, making the surgical technique more reliable and accurate.
Similar content being viewed by others
References
Maffulli N, Almekinders L (2007) The Achilles tendon. Springer, London
Lea RB, Smith L (1968) Rupture of the Achilles tendon. Nonsurgical treatment. Clin Orthop Relat Res 60:115–118
Kouvalchouk JF, Rodineau J, Watin Augouard L (1984) Ruptures of the Achilles tendon. Comparison of the results of surgical and nonsurgical treatment. Rev Chir Orthop Reparatrice Appar Mot 70(6):473–478
Metz R et al (2008) Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med 36(9):1688–1694
Bhandari M et al (2002) Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res 400:190–200
Kou J (2010) AAOS clinical practice guideline: acute Achilles tendon rupture. J Am Acad Orthop Surg 18(8):511–513
Moller M et al (2001) Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Jt Surg Br 83(6):843–848
Khan RJ et al (2005) Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Jt Surg Am 87(10):2202–2210
Cretnik A, Kosanovic M, Smrkolj V (2005) Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med 33(9):1369–1379
Delponte P et al (1992) Treatment of subcutaneous ruptures of the Achilles tendon by percutaneous tenorraphy. Rev Chir Orthop Reparatrice Appar Mot 78(6):404–407
Nistor L (1981) Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study. J Bone Jt Surg Am 63(3):394–399
Wong J, Barrass V, Maffulli N (2002) Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med 30(4):565–575
Blankstein A et al (2007) Percutaneous Achilles tendon repair combined with real-time sonography. Isr Med Assoc J 9(2):83–85
Ma GW, Griffith TG (1977) Percutaneous repair of acute closed ruptured Achilles tendon: a new technique. Clin Orthop Relat Res 128:247–255
Fortis AP, Dimas A, Lamprakis AA (2008) Repair of Achilles tendon rupture under endoscopic control. Arthroscopy 24(6):683–688
Turgut A et al (2002) Endoscopy, assisted percutaneous repair of the Achilles tendon ruptures: a cadaveric and clinical study. Knee Surg Sports Traumatol Arthrosc 10(2):130–133
Cetti R, Henriksen LO, Jacobsen KS (1994) A new treatment of ruptured Achilles tendons. A prospective randomized study. Clin Orthop Relat Res 308:155–165
Mortensen HM, Skov O, Jensen PE (1999) Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Jt Surg Am 81(7):983–990
Suchak AA et al (2008) The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Jt Surg Am 90(9):1876–1883
Webb JM, Bannister GC (1999) Percutaneous repair of the ruptured tendo achillis. J Bone Jt Surg Br 81(5):877–880
Rouvillain JL et al (2010) Percutaneous suture of acute Achilles tendon rupture. A study of 60 cases. Acta Orthop Belg 76(2):237–242
Maes R, Copin G, Averous C (2006) Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 72(2):179–1183
Webb J, Moorjani N, Radford M (2000) Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int 21(6):475–477
Morvan G et al (2001) Imagerie normale des muscles et des tendons du pied. Radiodiagnostic—Squelette normal—Neuroradiologie-Appareil Locomoteur. In: Encyclopédie Médico-Chirurgicale. Elsevier Masson SAS, Paris, p 12
Bleakney RR et al (2002) Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med 12(5):273–278
Miquel A et al (2009) Ultrasound of the Achilles tendon after percutaneous repair. J Radiol 90(3 Pt 1):305–309
Lyras DN et al (2009) The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int 30(11):1101–1106
Lopez-Vidriero E et al (2010) The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy 26(2):269–278
Conflict of interest
No funds were received in support of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lacoste, S., Cherrier, B. & Féron, J.M. Intra-operative ultrasonography in the percutaneous tenorraphy of acute Achilles tendon ruptures. Eur J Orthop Surg Traumatol 22, 585–591 (2012). https://doi.org/10.1007/s00590-011-0867-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-011-0867-x