Abstract
Purpose: Nowadays, surgical treatment of acute avulsions of the Achilles tendon represents a hard challenge. There is often the possibility that the calcaneus remains completely uncovered from the tendon, making the reinsertion of its distal stub complex. At the same time, the standard open surgical technique could cause difficult wound healing because of the weak blood supply, the increasing possibility of rupture, and the bacterial contamination. To overcome these risks, less invasive procedures should be considered. Methods: We developed an innovative minimally invasive procedure for fixation of acute avulsions of the Achilles tendon employing an integration of four longitudinal stab incisions and one distal semicircular Cincinnati incision. In this way, the distal Achilles tendon stub and the calcaneal insertion are exhibited. Results: We basted the tendon through percutaneous sutures performed across the four stab incisions with a Mayo needle threaded with Ultrabraid. The procedure is repeated with another loop of Ultrabraid. After having bruised the calcaneus bone insertion of the tendon, two sites for two suture anchors were prepared using a specific hole preparation device for the anchors’ footprint. Finally, we placed two suture anchors to reinsert the tendon to the calcaneal insertion. Conclusion: Our new less invasive technique is a promising alternative optional procedure for the Achilles tendon (AT) avulsion repair allowing clear exposure of the Achilles tendon insertion, maintaining the longitudinal wholeness of the dermis, and minimizing possible associated complications.
Highlights
An acute avulsion of the Achilles tendon (AT) from the calcaneus is not as frequent as the rupture of the AT, usually located 2–6 cm proximally to the calcaneal insertion [1,2,3,4]
As far as we know, no less invasive fixation has been mentioned for the surgical treatment of acute avulsions of the AT
We described a new minimally invasive surgical procedure for fixation of acute avulsions of the AT using an integration of four longitudinal stab incisions and one distal Cincinnati cut, showing the distal AT piece and its insertion
Summary
An acute avulsion of the Achilles tendon (AT) from the calcaneus is not as frequent as the rupture of the AT, usually located 2–6 cm proximally to the calcaneal insertion [1,2,3,4]. Open surgical techniques have shown an increased risk of failure of wound healing due to insubstantial blood supply and the subsequent risk of bacterial contamination (9%). To overcome these risks, less invasive procedures have been described for the treatment of AT tendinopathy [9,10,11], acute AT ruptures [12], chronic AT ruptures [13,14,15,16,17,18], chronic AT avulsions [3]. As far as we know, no less invasive fixation has been mentioned for the surgical treatment of acute avulsions of the AT
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have