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The percutaneous suture of the Achilles tendon with the Dresden instrument
Michael H Amlang1, Paula Christiani, Peter Heinz
1Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus Technische Universität Dresden. Michael.Amlang@uniklinikum-dresden.de
Objective:
Minimally invasive suture of the torn Achilles tendon without opening the rupture site, reduction in the risk of a sural nerve lesion, and optimization of stump apposition.
Indications:
Fresh Achilles tendon rupture.
Contraindications:
Chronic achillodynia, local corticoid injections, immunosuppressive therapy, old Achilles tendon ruptures, rerupture.
Surgical Technique:
Suture of the Achilles tendon with a special instrument via a skin incision proximal to the rupture, without opening the peritenon or the rupture site, whereby the suture in the area of the proximal Achilles tendon is placed in the layer between the lower-leg fascia and the peritenon with the threads running in a paratendinous direction.
Results:
From January 1, 2000 to December 31, 2003, 61 patients with 62 Achilles tendon ruptures were sutured using the percutaneous technique with the Dresden Instrument. No sural nerve lesions and only two reruptures (3.2%) were observed. In one patient (1.6%) a superficial late infection occurred after 8 weeks, when the tendon was already healed. Of 47 patients with a follow-up time of at least 1 year, 39 with 40 Achilles tendon ruptures were followed up (83%). According to the criteria of Trillat & Mounier-Kuhn, the result was very good in 62% and good in 30%. On the AOFAS Score, an average of 96 points (78-100 points) was achieved. 78% of the patients assessed the result of the treatment as very good and 20% as good.
