NEW YORK (Reuters Health) Mar 07 - A new Achilles tendon repair procedure, which allows precise control of the tendon ends while avoiding excessive dissection, is associated with a high success rate and minimal morbidity, according to a recent report.
Surgeons often favor an open repair method to reduce the risk of rerupture. However, such an approach involves much soft tissue dissection and has been associated with wound-healing problems and infection.

To overcome these problems, Dr. Richard Stern, from Hopital Cantonal Universitaire in Geneva, and colleagues performed a cadaver study to develop an instrument and technique that would provide the benefits of open repair without the described complications.

The researchers developed a guiding instrument, known as the Achillon, which allows the passage of three sutures into the proximal and distal ends of the tendon with only a small skin incision and limited soft tissue dissection. The instrument is then removed, and the corresponding proximal and distal sutures are tied to achieve tendon approximation.

The investigators tested the new procedure on 87 patients with Achilles tendon ruptures. Four of the patients were lost to follow-up, and another patient died of an unrelated cause. The average follow-up period was 26 months.

No wound healing problems or infections were noted, and none of the patients experienced sensory disturbances in the sural nerve distribution, the authors state in the February issue of The Journal of Bone and Joint Surgery.

All of the patients returned to their previous professional or sporting activities. In addition, isokinetic dynamometric testing in 50 patients revealed that the injured limb was just as strong as the uninjured limb.

Early failure of the repair occurred in two patients, but both were noncompliant with the required orthosis. Another patient experienced a rerupture after falling off a bicycle 12 weeks after surgery. All three patients were successfully treated with an open repair.

"With our new instrument and limited open technique we have been able to directly visualize the repair site and provide precise apposition of the tendon ends," the authors note. "This has allowed us to optimize the tension in the muscle-tendon unit while limiting the surgical dissection and hopefully minimizing the disturbance of the local blood supply."

J Bone Joint Surg Am 2002;84-A:161-169.

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