Surgical repair of the Achilles tendon using a posterolateral paramedian incision

Abstract

Introduction: Operative reconstruction is the preferred method of treatment for ruptured Achilles tendons in most patients. Several surgical approaches have been described. Sural nerve injury has been reported with each method. We believe that a lateral paramedian incision that allows direct visualisation and isolation of the sural nerve will reduce the frequency of nerve injury.Methods: A retrospective case control study in which we compared 34 patients from the open posterolateral paramedian approach with 33 patients in the standard open posteromedial paramedian incision. All patients in the posterolateral incision group were treated by the senior author using a 2 ethibond Krakow suture and wore a below knee plaster cast for 6 weeks followed by a heel raise for 4 weeks. In the second group, a 1 PDS modified Kessler core suture was used and patients were treated in cast for 8 weeks. All patients were recalled and 35 patients returned and clinically assessed. Calf circumference, Tendon width, AOFAS and Hannover Achilles Tendon Scores were completed in each case.Results: There were no significant wound complications.2 patients had re-ruptures in posteromedial group. Two patients in the posterolateral incision group had transient parasthesiae in the foot post-operatively. Both resolved within two weeks. The mean AOFAS scores in the posterolateral group was 89 compared with 85 in the posteromedial group (p = 0.76) while Hannover Achilles Tendon Scores (posteromedial 79/100, posterolateral 84/100, p = 0.45).Discussion: In our study both groups of patients had favourable outcomes, regardless of the surgical approach used. We did not identify a reduced incidence of sural nerve injury in the posterolateral incision group. The 2 cases of transient parasthesiae may have been due to traction on the sural nerve intra-operatively. We believe that a posterolateral incision is a safe and technically easy surgical approach in the reconstruction of Achilles tendon ruptures.