Achilles Tendon Ruptures: Limited Incision Repair

Abstract

Achilles tendon ruptures are a common injury, and a steadily rising incidence has been noted since the middle of the 20th century. Conservative management is a recognized treatment method, but it bears a higher risk of tendon rerupture compared with surgical treatment. Standard open surgery, however, can lead to complications, such as wound complications and surgical site infection. Hence, efforts have been put into the development of alternative surgical techniques to lower the risk of complications. In the 1970s, Ma and Griffith introduced percutaneous tendon repair by limiting the incision to 6 stab wounds. Subsequently, the open and percutaneous approaches have been merged into limited incision procedures, which include the advantages of both: visual control as well as smaller incisions. The primary limited incision approach consisted in using twisted Kirschner wires as suture guides. They were replaced by specific guiding instruments, such as the Achillon and Percutaneous Achilles Repair System (PARS) device, which rendered the limited incision procedure safer and more standardized. The instruments consist of 4 arms: The outer arms facilitate needle introduction by predetermined holes, the inner arms allow for suture passage exclusively underneath the tendon sheath. The minimally invasive procedures may reduce complication rates, especially regarding wound healing and infection. Limited incision techniques also may reduce sural nerve injury. Level of Evidence: Diagnostic Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.