Minimal Invasive Percutaneous Repair of Acute Closed Rupture of Achilles Tendon

Rupture of the Achilles tendon is increasingly common, and an incidence of 18 per 100,000 has been reported. The Achilles tendon is the strongest tendon in the human body which takes its name from Achilles, from Homer’s Iliad. Hippocrates said “this tendon, if bruised or cut, causes the most acute fevers, induces choking, deranges the mind and at length brings death”. Since Ambroise Paré initially described in 1575 and reported in the literature in 1633, Achilles tendon breakage has received a lot of attention.

The current treatment options can be classified as non-operative (casting or functional bracing) or operative. Although some authors recommend conservative management strongly, cast immobilization may lead to elongation of the tendon with reduced strength of the calf muscles and in a high rate of re-rupture.

As a common concept, operative regiments present a lower rerupture rate, early functional rehabilitation, stronger push off with lower incidence of calf atrophy. But open surgical repair of the Achilles tendon also includes potential problems like joint stiffness, muscles atrophy, tendo-cutaneous adhesions, deep venous thrombosis due to prolonged immobilization after surgical repair, infection, scarification, and wound breakdown.

Percutaneous repair was described in 1977 by Ma and Griffith with no re-ruptures and only two minor complications; these have led some authors to develop new and alternative methods of percutaneous repair. Percutaneous or minimally invasive techniques are being used to minimize the typical complications associated with open surgery, and results are reported to be satisfactory, but an increased incidence of sural nerve injury has been reported after percutaneous repair.