Abstract
Minimally invasive and percutaneous Achilles tendon repair technique allows direct visualization of end-to-end apposition of the ruptured tendon ends whilst minimizing risks of wound breakdown and infection and improving cosmesis. Although they have these advantages, traditional percutaneous repair techniques have been estimated to have half the strength of open repair methods and also present a risk of iatrogenic sural nerve injury. Biomechanical studies have compared box, Bunnell, modified Bunnell, Kessler and Krackow suture configurations in tendon repair models. The mode of failure of percutaneous repair models is the most commonly suture pull out of the distal Achilles stump, at the tendon suture interface. This leads to the separation of the apposed tendon ends and elongation of the healing tendon. In stronger Krackow sutures, with locking loops, failure tends to occur at the suture knots; however, the insertion of these sutures requires greater access and an open repair.
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References
Clanton TO, Haytmanek CT, Williams BT, Civitarese DM, Turnbull TL, Massey MS, Wijdicks CA, LaPrade RF. A biomechanical comparison of an open repair and 3 minimally invasive percutaneous Achilles tendon repair techniques during simulated progressive rehabilitation protocol. Am J Sports Med. 2015;43(8):1957–64.
Groetelaers RPTGC, Janssen L, van der Velden J, Wieland AWJ, Amendt AGFM, Geelen PHJ, Janzing HMJ. Functional treatment or cast immobilization after minimally invasive repair of an acute Achilles tendon rupture: prospective randomized trial. Foot Ankle Int. 2014;35(8):771–8.
Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB. Clinical outcomes and complications of percutaneous Achilles repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int. 2015;36(11):1279–86.
Huh J, Easley ME, Nunley JA. Characterization and surgical management of Achilles tendon sleeve avulsions. Foot Ankle Int. 2016;37(6):596–604.
Metz R, van der Heijden GJ, Verleisdonk EJ, Tamminga R, van der Werken C. Persistent disability despite sufficient calf muscle strength after re-rupture of surgically treated acute Achilles tendon ruptures. Foot Ankle Spec. 2011;4(2):77–81.
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Carmont, M.R., Mackay, G., Ribbans, B. (2017). Repair of Distal Achilles Tendon Rupture and Reattachment. In: Thermann, H., et al. The Achilles Tendon. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54074-9_6
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DOI: https://doi.org/10.1007/978-3-662-54074-9_6
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