gms | German Medical Science

With the description by Ma et al. of percutaneous suture, we have an alternative surgical treatment option for Achilles tendon ruptures. The advantages and disadvantages of this method compared to open suture technique or even compared to primary functional treatment have repeatedly been the topic of controversial discussions.

Between December 1997 and December 2003, 107 patients with an enclosed rupture of the Achilles tendon were treated by percutaneous suture at our hospital. The postoperative follow-up extends thus far on average over a period of 26 months. The objective of this prospective study was to examine the method of percutaneous suture for effectiveness and to collect data material on the complications described in the literature. In order to minimize the risk of injury to the Nervus Suralis, we used a modified positioning of the penetration incisions. Moreover, in adaptation of the original technique, a straight needle was used to draw the suture material and the torn structures were threaded in a different sequence.

96 patients were available for follow-up. The patients who had been active in sports prior to their accident were able to participate once again in sports. No impairment of wound healing was observed. 4 patients suffered sensitivity impairment of the Nervus-Suralis. This abated completely in 3 patients over time. 2 patients suffered re-rupture of the Achilles tendon requiring open reconstruction.

The re-rupture rate is not higher than that following open technique. Percutaneous suture offers an interesting alternative to the open technique in the treatment of Achilles tendon rupture. The danger of injury to the Nervus Suralis could be reduced by a modification to the method.