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Minimal Invasive Percutaneous Repair of Acute Closed Rupture of Achilles Tendon

Mohamed Hamed Fahmy*

Background: Achilles tendon injuries are fairly common nowadays due to prevalence of comorbid conditions. The proposed lines of treatment in the literature are conservative treatment with cast immobilization, open surgical repair and minimal invasive lines of treatment with percutaneous repair. To achieve optimum return of function, surgical repair is clearly superior to non-operative treatment. Purpose: The purpose of this study is to determine the results of minimal invasive Percutaneous repair of acute closed rupture of Achilles tendon with special emphasis on how to protect the sural nerve during the procedure.
Patients and methods: Twelve patients with acute closed rupture of Achilles tendon were treated between November 2010 and 2012. Ten patients were males and two patients were females. The mean age of the patients was 35.5 years. The mean time between injury and index surgery was 8 days (range 5 to 14 days).
Results: The average range of ankle plantar flexion was 130° (range, 120°-140°) on the repaired side and 143° (range, 120°- 155°) on the non-injured side. The average range of ankle dorsiflexion was 17° (range, 16°-21°) on the operated side and 19° (range, 18°-22°) on the non- injured side. The mean calf diameter was 38.5 cm (range, 36-44 cm) on the operated side and 42.5 cm (range, 39-45 cm) on the non- injured side. The interval between injury and return to regular work was 17 weeks (range 16-18 weeks). The mean AOFAS score was 90 (80-98) at the most recent follow-up and 75% of patients’ results were considered excellent while 25% were good. We had no re-ruptures.
Conclusion: Percutaneous repair of acute closed rupture of Achilles tendon is a reproducible and effective method of treatment. It results into a strong and sound tendon healing in a relatively short time that allowed for early functional rehabilitation. The only drawback of this technique is the sural nerve injury. This can be eliminated by direct visualization of the nerve by very minimal blunt dissection through the lateral stab incisions.