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Background Chronic Achilles tendon rupture is commonly defined as a rupture presenting 6 weeks after the time of injury and operative management is recommended. This research aims to describe a novel modified surgical technique in the repair of chronic Achilles tendon rupture and to report the result of this technique. Methods This is a retrospective study performed between January 2007 and January 2017, and a novel modification of El Shewy et al.'s surgical technique is described. Fifteen patients with chronic rupture of Achilles tendon repaired with the technique by a single experienced surgeon were identified. Patients were contacted via phone call and questionnaires completed. Achilles Tendon Rupture Score and pain score were assessed via questionnaires. Results Thirteen patients were contacted and two patients were uncontactable. Ten patients were able to return to their premorbid level of function. Twelve patients were satisfied or very satisfied with the outcome. Only one patient was very dissatisfied with the outcome. The average Achilles Tendon Rupture score was 72 (n = 7, 54%). The average pain score was 1.23 (n = 13, 100%). Conclusions This novel modified surgical technique demonstrated good functional outcomes and high levels of patient satisfaction in patient with chronic Achilles tendon rupture. It can be considered in the repair of chronic Achilles tendon rupture.

Pudendal nerve injuries are not an uncommon side effect of patient positioning on a traction table, and muscle relaxation has been suggested to mitigate this risk by reducing pressure on the perineum. A total of 40 patients scheduled for hip arthroscopic surgery under general anaesthesia were recruited. After induction of anaesthesia, pressures on the perineum were measured in 20 subjects by means of an ultra-thin pressure sensor mat wrapped around the perineal post. Perineal pressures were assessed after the induction of anaesthesia, after leg traction and after deep muscle relaxation. In 22 subjects, the hip joint width was measured radiographically at the same time points. Pressures on the perineum were high after traction (median maximum pressure 2540 g cm−2). Neuromuscular paralysis reduced perineal pressures only minimally, but significantly (−5 g cm−2; P = 0.007). Traction increased hip joint width significantly [mean 66 (12)%; P = 0.001) and muscle relaxation further increased joint width by a mean of 3.2 (0–20)% (P = 0.001). Muscle relaxation was more beneficial for male patients (joint width increase 6.8% versus 2.8%; P = 0.04), as well as patients in whom traction alone did not achieve sufficient joint width. Muscle relaxation reduced the perineal pressure during hip arthroscopic surgery by only a negligible amount. With regard to joint space, relaxation may be of highest benefit in male patients and/or patients in whom traction alone produces only a relatively small increase in joint width (trial registration: ANZCTR 12617000191392).

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