Abstract
BackgroundPercutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. Sural nerve lesions are the major problem to avoid with the technique. A new device was therefore designed for suturing the AT, resulting in channel-assisted minimally invasive repair (CAMIR). The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques.MethodEighty two patients with AT rupture were included: 41 for CAMIR, 41 for open repair. All patients followed a standardized rehabilitation protocol. Follow-ups were at 12 and 24 months after surgery. Functional evaluation was based on the clinical American Orthopaedic Foot & Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM), and isometric testing.ResultsThere was no difference between groups regarding plantar flexor strength, ankle ROM, or calf circumference. CAMIR significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001). Mean scar length was greater in the open repair group (10 vs. 2 cm, P < 0.0001). There were no wound complications in the CAMIR group but four in the open repair group (P < 0.0001). No deep vein thrombosis, rerupture, or sural nerve injury occurred.ConclusionCAMIR and open repair yielded essentially identical clinical and functional outcomes. Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique.
Highlights
Repair of Achilles tendon (AT) ruptures include conservative management using a short-leg resting cast or brace in an equinus position as well as percutaneous, minimally invasive surgery and open sutures with or without augmentation [1, 2]
channel-assisted minimally invasive repair (CAMIR) significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001)
Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique
Summary
Repair of Achilles tendon (AT) ruptures include conservative management using a short-leg resting cast or brace in an equinus position as well as percutaneous, minimally invasive surgery and open sutures with or without augmentation [1, 2]. Some surgeons advocate operative repair because open treatment can ensure tendon approximation and has a lower rerupture rate [4]. It is associated with a higher complication rate, including wound infections, skin tethering, sural nerve lesions, and hypertrophic scars, which have caused anxiety for both doctors and patients [2]. Percutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques
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