Dynamic percutaneous repair of the ruptured tendo Achillis.

Abstract

We have modified the traditional percutaneous repair of the ruptured tendo Achillis so to obtain a lower rate of complications than in open repair, a low rate of re-rupture and an early mobilization and return to full weight bearing and sport activities especially in professional sportsmen. We reviewed 80 patients (52 men and 28 women), 10 of which were professional athletes. We have named this technique "dynamic percutaneous suture" (DPS). The repair was carried out using 10 micro-incisions, 5 laterals and 5 medial to the posterior aspects of the tendon with absorbable suture. We used one suture through the four proximal incisions in an 8-shaped and one suture through the four distal as well. The patients were assessed according to the criteria established by the clinical AOFAS rating score. No re-rupture or sural nerve damages were observed. In all the treated patients, the results obtained were rated from good to excellent. One patient had mild disturbances of sensibility over the lateral heels (completely resolved in 2 months), and two patients had scar adhesions. The absorbable suture permits what we call a "dynamic" healing of the tendon, through an "elastic" fixation of the two stumps, as in the healing of a fractured long bone treated with a dynamic nail fixation. We so obtained a short immobilization time and an early full motion and weight bearing. Return to sport activities was permitted in 8-12 weeks.