Minimally invasive achilles tendon repair

Abstract

There is currently no consensus regarding the optimal management for acute Achilles tendon ruptures. Nonoperative treatments present comparable results to operative treatments with fewer wound-healing problems but eventually slower return to previous activities and a higher rerupture rate if no accelerated and functional rehabilitation is performed. Regarding surgical treatment, good clinical results have been shown with open suturing techniques, but they also have been associated with superficial and deep wound complications, driving enthusiasm to minimally invasive surgical procedures. These latter techniques have been developed to improve recovery and final function and cosmetic appearance and reduce postoperative soft tissue complications observed with open repairs. Some mini-open techniques like the Achillon or Pars techniques open the Achilles rupture site evacuating the hematoma and losing its theoretical healing potential. An intrinsic sural nerve damage risk is present given their percutaneous nature. Besides, they use specific and expensive instruments being some of them single use only. The authors’ preferred minimally invasive technique is the Dresden procedure. This procedure is performed through a small, longitudinal paramedian incision proximal-medial to the tendon rupture site, using a specific surgical interval between the superficial fascia and the paratenon. This interval is used as a working space to perform the tenorrhaphy using inexpensive and easily available instrumentation. The paratenon is preserved, the local hematoma is untouched, and the sural nerve is avoided given its passage above the fascia. This technique is reproducible, easy to teach, and inexpensive, reduces wound-healing complications in comparison to open techniques, avoids sural nerve damage, and shows good functional long-term results. Complications such as reruptures and infection are comparable to other mini-open techniques.