Endoscopic Assisted Percutaneous Achilles Tendon Repair

  • Mahmut Nedim DoralEmail author
  • Murat Bozkurt
  • Egemen Turhan
  • Ozgür Ahmet Atay


The Achilles tendon is the strongest tendon in the human body.1 Hippocrates said “this tendon, if bruised or cut, causes the most acute fevers, induces choking, deranges the mind and at length brings death.”2 Achilles tendon rupture has been the focus of many studies since Ambroise Paré initially described it in 1575.3 Achilles tendon ruptures are the third most frequent major tendon ruptures, following rotator cuff and quadriceps ruptures.4,5 Nevertheless, there is no consensus on the optimal management, and management is still determined by the preferences of the surgeon and the patient. Cast immobilization may lead to suboptimal healing, with elongation of the tendon, reduced strength of the calf muscles, and an unacceptably high rate of re-rupture.6–10


Achilles Tendon Sural Nerve Plantar Flexion Calf Muscle Stab Wound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank to Professor Nicola Maffulli for his support and Dr. M. Ayvaz and Dr. G. Dönmez for archiving and pictures.


  1. 1.
    Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg (Am). 1999;81:1019–1036.Google Scholar
  2. 2.
    Carden DG, Noble J, Chalmers J et al. Rupture of the calcaneal tendon. The early and late management. J Bone Joint Surg (Br). 1987;69:416–420.Google Scholar
  3. 3.
    Cetti R, Christensen SE, Ejsted R et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993;21:791–799.PubMedCrossRefGoogle Scholar
  4. 4.
    Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle. 1985;6:34–38.PubMedCrossRefGoogle Scholar
  5. 5.
    Weiner AD, Lipscomb PR Rupture of muscles and tendons. Minn Med. 1956;39:731–736.PubMedGoogle Scholar
  6. 6.
    Edna TH. Non-operative treatment of Achilles tendon ruptures. Acta Orthop Scand. 1980;51:991–993.PubMedCrossRefGoogle Scholar
  7. 7.
    Fierro N, Sallis R Achilles tendon rupture: is casting enough? Postgrad Med. 1995;98:145–151.Google Scholar
  8. 8.
    Inglis AE, Scott WN, Sculco TP et al. Ruptures of the tendo Achillis. J Bone Joint Surg (Am). 1976;58:990–993.Google Scholar
  9. 9.
    Jacobs D, Martens M, Van Audekercke R et al. Comparison of conservative and operative treatment of Achilles tendon ruptures. Am J Sports Med. 1978;6:107–111.PubMedCrossRefGoogle Scholar
  10. 10.
    Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:277–279.PubMedCrossRefGoogle Scholar
  11. 11.
    Aoki M, Ogiwara N, Ohta T, Nabeta Y Early active motion and weightbearing after cross-stitch achilles tendon repair. Am J Sports Med. Nov–Dec 1998;26:794–800.PubMedGoogle Scholar
  12. 12.
    Bhandari M, Guyatt GH, Siddique F et al. Treatment of acute Achilles tendon ruptures a systematic overview and meta-analysis. Clin Orthop. 2002;400:190–200.PubMedCrossRefGoogle Scholar
  13. 13.
    Kangas J, Pajala A, Siira P et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma. 2003;54:1171–1180.PubMedCrossRefGoogle Scholar
  14. 14.
    Mortensen NHM, Skov O, Jensen PE. Early motion of the ankle after operative treatment of a rupture of the Achilles tendon: a prospective randomized clinical and radiographic study. J Bone Joint Surg (Am). 1999;81:983–990.Google Scholar
  15. 15.
    Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured Achilles tendon. A new technique. Clin Orthop. 1977;128:247–255.PubMedGoogle Scholar
  16. 16.
    Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov. July–Sept 1991;76:223–228 (English, Italian).PubMedGoogle Scholar
  17. 17.
    Rowley DI, Scotland TR. Rupture of the Achilles tendon treated by a simple operative procedure. Injury. 1982;14:252–254.PubMedCrossRefGoogle Scholar
  18. 18.
    Tang KL, Thermann H, Dai G, Chen GX, Guo L, Yang L. Arthroscopically assisted percutaneous repair of fresh closed Achilles tendon rupture by Kesslers suture. Am J Sports Med. 2007;35:589–596.PubMedCrossRefGoogle Scholar
  19. 19.
    Thermann H, Tibesku CO, Mastrokalos DS, Pässler HH. Endoscopically assisted percutaneous achilles tendon suture. Foot Ankle Int. 2001;22:158–160.PubMedGoogle Scholar
  20. 20.
    Halasi T, Tállay A, Berkes I. Percutaneous Achilles tendon repair with and without endoscopic control. Knee Surg Sports Traumatol Arthrosc. 2003;11:409–414.PubMedCrossRefGoogle Scholar
  21. 21.
    Rebeccato A, Santini S, Salmaso G, Nogarin L. Repair of the achilles tendon rupture: a functional comparison of three surgical techniques. J Foot Ankle Surg. 2001;40:188–194.PubMedCrossRefGoogle Scholar
  22. 22.
    Tang KL, Thermann H, Dai G, Chen GX, Guo L, Yang L. Arthroscopically assisted percutaneous repair of fresh closed achilles tendon rupture by Kesslers suture. Am J Sports Med. 2007;35:589–596.PubMedCrossRefGoogle Scholar
  23. 23.
    Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg (Br). 1999;81:877–880.CrossRefGoogle Scholar
  24. 24.
    Buchgrabber A, Pässler HH. Percutaneous repair of Achilles tendon rupture. Immobilization versus functional postoperative treatment. Clin Orthop. 1997;341:113–122.Google Scholar
  25. 25.
    McClelland D, Maffulli N. Percutaneous repair of ruptured Achilles tendon. J R Coll Surg Edinb. 2002;47:613–618.PubMedGoogle Scholar
  26. 26.
    Momose T, Amadio PC, Zobitz ME, Zhao C, An KN. Effect of paratenon and repetitive motion on the gliding resistance of tendon of extrasynovial origin. Clin Anat. 2002;15:199–205.PubMedCrossRefGoogle Scholar
  27. 27.
    Doral MN, Tetik O, Atay OA, Leblebicioğlu G, Oznur A. Achilles tendon diseases and its management. Acta Orthop Traumatol Turc. 2002;36:42–46.PubMedGoogle Scholar
  28. 28.
    Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:199–203.PubMedCrossRefGoogle Scholar
  29. 29.
    Ebinesan AD, Sarai BS, Walley GD, Maffulli N. Conservative, open or percutaneosus repair for acute rupture of the Achilles tendon. Disabil Rehabil. 2008;30:1721–1725.PubMedCrossRefGoogle Scholar

Copyright information

© Springer London 2010

Authors and Affiliations

  • Mahmut Nedim Doral
    • 1
    Email author
  • Murat Bozkurt
  • Egemen Turhan
  • Ozgür Ahmet Atay
  1. 1.Department of Orthopedics and TraumatologyHacettepe UniversityAnkaraTurkey

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