Evaluation of Anatomic Relationship Between Sural Nerve and Instrumentation During Mini-Open Achilles Tendon Repair: A Cadaveric Study

Abstract

The purpose of this study was to determine the relationship of the sural nerve to the Arthrex Percutaneous Achilles Repair System (PARS) jig and repair sutures. We performed cadaveric dissection on 10 unpaired above-knee amputation specimens (6 were right legs and 4 were left legs). In all but 1 cadaver, all of the sutures either punctured the nerve or passed anterior to it. Only 1 cadaver had sutures that were posterior to the sural nerve. In all cases, removal of the jig pulled the sutures through the nerve and the nerve was completely free after locking the sutures, and the sural nerve was within 1 cm of the lateral aspect of the transverse incision made for insertion of the jig. This cadaveric study revealed a high rate of sural nerve puncture when passing needles across the Achilles tendon using a commercially available minimally invasive repair device. This finding should caution users of Arthrex PARS jig to be attentive to postoperative symptoms of nerve injury.Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Primary Repair of Achilles Tendon Rupture Using a Mini-incision: A Novel Technique

“…A main concern in minimally invasive techniques is the risk of damage or entrapment of the sural nerve, especially when grasping the proximal stump percutaneously, with no direct visualization of the nerve. Krautmann et al 7 evaluated the anatomic relationship between the sural nerve and percutaneous instrumentation with the Percutaneous Achilles Repair System (Arthrex Inc., Naples, FL) and identified that the nerve was punctured 18% of the times (4 of 10 specimens), although in all cases the removal of the jig pulled the sutures through the nerve and the nerve was freed again.…”