Knotless Reconstruction of Chronic Achilles Tendon Ruptures With <3-cm Defects: Technique Tip

Abstract

Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.

Ultrasound evaluation of a new surface reference line to describe sural nerve location and safe zones to consider in posterior leg approaches

“…Therefore, according to our series, incisions medial to the reference line with a minimum distance of 20 mm, 10 mm, 10 mm and 0 mm from Points 1, 2, 3 and 4, respectively, would be safe to perform (Table 4 ). Proximal zones and points may be useful in revision surgery or chronic Achilles tendon rupture surgery [ 16 , 31 , 41 , 44 ] or in some Achilles tendon lengthening techniques [ 7 , 10 , 19 , 41 ]. The central zones may be useful in acute Achilles pathology surgeries [ 12 , 22 , 35 , 47 ] and distal zones in arthroscopic surgeries [ 2 , 23 , 34 ] or ankle fractures [ 18 , 29 , 33 ].…”

“…Some posterior leg approaches have a high risk of SN injury [ 30 , 47 ]. These approaches are often used in acute [ 12 , 35 , 47 ] or chronic [ 16 , 44 ] Achilles pathology, ankle arthroscopy [ 2 , 23 , 34 ] or ankle fractures [ 18 , 29 , 33 ]. Several authors have attempted to predict the SN location with distance units from the Achilles tendon [ 6 , 10 , 14 , 20 , 46 ] or the lateral malleolus [ 9 , 14 , 15 , 18 , 24 , 30 ], but these units can be altered according to height [ 15 , 20 ], leg length [ 6 ] or body mass index (BMI) [ 15 ].…”

Endoscopic-assisted locking block modified Krackow technique combined with a V-Y flap for chronic Achilles tendon rupture

“…Chronic rupture of the Achilles tendon often leads to severe calf muscle dysfunction and gait abnormalities and surgical intervention is generally required [6, 16, 27, 30, 39]. However, owing to a long gap between the two rupture ends of the Achilles tendon, treating chronic Achilles tendon rupture is challenging [14].…”