Prospective Randomized Controlled Study on an Innovative Mini-open Technique Versus Standard Percutaneous Technique to Avoid Sural Nerve Injury During Acute Achilles Tendon Repair

Abstract

Percutaneous and mini-open repair of the tendo-Achilles have proved good results according to several authors. However, sural nerve injury is one of the most important complications that may be associated with this technique because of either entangling the nerve inside the suture laterally or piercing the nerve with the needle. The authors present a simple and reproducible technique to avoid injury of the sural nerve with the mini-open repair of the Achilles tendon. The patients were split into 2 groups, each consisted of 20 patients. They were randomly allocated using identical envelopes to either treatment by the new modified technique of surgical repair. The study group, and the conventional mini-open technique; the control group. The patients were assessed clinically at 1, 6, 12 months, and at the end of follow-up postoperatively. The outcome was assessed using the Weber Modification of Thermann score. The demographic data and the gap size were comparable between both groups with no statistical significance. The mean Weber Modification of Thermann score For the study group was 86 (range, 80 to 95; SD, 5.062). It was better than that for the control group (mean, 83.25; range, 75 to 90; SD, 4.375). This was statistically significant (P=0.036). None of the cases in group I developed sural nerve injury, whereas 7 cases (35%) in group II developed sural nerve injury, and this was statistically significant (P=0.003*). None of the patients in both groups developed rerupture, surgical site tenderness, or skin-related complications. Our innovative surgical technique permitted avoidance of injury of the sural nerve during mini-open Achilles tendon repair, meanwhile retained all the advantages of the mini-open repair. Level of Evidence: Level I—a prospective randomized clinical trial.