Intra-operative ultrasonography in the percutaneous tenorraphy of acute Achilles tendon ruptures

Abstract

The management of acute Achilles tendon ruptures is still controversy. Some current recommendations are in support of the surgical option with early rehabilitation. The percutaneous technique is a compromise between the conservative treatment and the open surgery. It allows a correct connection of the tendon ends with a lower skin and infection complications. According to some studies, reruptures and sural nerve injuries rates are still significant with the percutaneous technique. We tried to find a way to improve the percutaneous option. The subcutaneous position of the tendon makes its ultrasonographic exploration easy. The ultrasonography seemed to represent a non-invasive tool for guiding the percutaneous tenorraphy. The aim of our study is the evaluation of the intra-operative ultrasonography in the Achilles tendon percutaneous technique. We compared two groups according to the percutaneous tenorraphy and early rehabilitation. The first group (group A, 21 patients) was ultrasound-controlled during the operation, and the second one (group B, 12 patients) without control. The mean follow-up in the group A was 12 months and 24.5 months in the second group. In the ultrasonography group, we did not find neither general complication, neither iterative rupture nor sural nerve injury. The return to work was observed earlier in the group A at 45 days. There was no significant difference between skin necrosis, return to sport, plantar flexion strength and calf muscle atrophy. The economic impact was considered lower by patients in the group A. The ultrasonography contribution is certain, making the surgical technique more reliable and accurate.