open access

Vol 75, No 1 (2016)
ORIGINAL ARTICLES
Published online: 2016-02-29
Submitted: 2015-04-16
Accepted: 2015-06-23
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Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury

A. Makulavicius, X. Martin Oliva, G. Mazarevicius, M. Klinga, V. Uvarovas, N. Porvaneckas, M. Monzó Planella, T. Mazurek
DOI: 10.5603/FM.a2015.0067
·
Folia Morphol 2016;75(1):53-59.

open access

Vol 75, No 1 (2016)
ORIGINAL ARTICLES
Published online: 2016-02-29
Submitted: 2015-04-16
Accepted: 2015-06-23

Abstract

Background: Less invasive percutaneous acute Achilles tendon rupture (AATR) repair techniques gain popularity because of lower risk of surgical wound complications. But these approaches have an increased risk of sural nerve iatrogenic injury as this sensory nerve is usually not visualised during minimally invasive operative procedures. We compared standard percutaneous Bunnell type and our proposed modified-medialised percutaneous technique in a cadaver study to evaluate potential advantages.

Materials and methods: Ten pairs of fresh frozen specimens were divided into two groups for comparative anatomical study. Tenotomies of Achilles tendons were made and wounds sutured. Ten standard and 10 modified-medialised repairs were applied for artificially performed ruptures. All sutured tendons were dissected meticulously. We carefully looked at repaired Achilles tendon end-to-end contact and adaptation, distance from Achilles insertion in calcaneal tubercle to place where sural nerve crosses lateral border of the Achilles tendon and possible sural nerve and vein entrapment. Groups were compared using Fisher’s exact and Student-T tests.

Results: All ends of sharply dissected tendons in both groups were in sufficient contact. No measurable diastasis between tendon ends was found in all cases. No entrapment of sural nerve or vein was found in modified percutaneous Bunnell suture technique group, whereas 7 of 10 sural nerves and 9 small saphenous veins were entrapped when using standard percutaneous Bunnell type technique. Average distance from Achilles tendon insertion in tuber calcanei to sural nerve crossing the lateral border of Achilles was 93 mm.

Conclusions: Medialisation of percutaneous suture in AATR repair shows clear advantages compared to standard non medialised technique ensuring a possible lower incidence of sural nerve entrapment injury. Our modified percutaneous Bunnell type technique allows sufficient adaptation of ruptured Achilles tendon.  

Abstract

Background: Less invasive percutaneous acute Achilles tendon rupture (AATR) repair techniques gain popularity because of lower risk of surgical wound complications. But these approaches have an increased risk of sural nerve iatrogenic injury as this sensory nerve is usually not visualised during minimally invasive operative procedures. We compared standard percutaneous Bunnell type and our proposed modified-medialised percutaneous technique in a cadaver study to evaluate potential advantages.

Materials and methods: Ten pairs of fresh frozen specimens were divided into two groups for comparative anatomical study. Tenotomies of Achilles tendons were made and wounds sutured. Ten standard and 10 modified-medialised repairs were applied for artificially performed ruptures. All sutured tendons were dissected meticulously. We carefully looked at repaired Achilles tendon end-to-end contact and adaptation, distance from Achilles insertion in calcaneal tubercle to place where sural nerve crosses lateral border of the Achilles tendon and possible sural nerve and vein entrapment. Groups were compared using Fisher’s exact and Student-T tests.

Results: All ends of sharply dissected tendons in both groups were in sufficient contact. No measurable diastasis between tendon ends was found in all cases. No entrapment of sural nerve or vein was found in modified percutaneous Bunnell suture technique group, whereas 7 of 10 sural nerves and 9 small saphenous veins were entrapped when using standard percutaneous Bunnell type technique. Average distance from Achilles tendon insertion in tuber calcanei to sural nerve crossing the lateral border of Achilles was 93 mm.

Conclusions: Medialisation of percutaneous suture in AATR repair shows clear advantages compared to standard non medialised technique ensuring a possible lower incidence of sural nerve entrapment injury. Our modified percutaneous Bunnell type technique allows sufficient adaptation of ruptured Achilles tendon.  

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Keywords

Achilles repair, percutaneous, medialisation

About this article
Title

Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury

Journal

Folia Morphologica

Issue

Vol 75, No 1 (2016)

Pages

53-59

Published online

2016-02-29

DOI

10.5603/FM.a2015.0067

Bibliographic record

Folia Morphol 2016;75(1):53-59.

Keywords

Achilles repair
percutaneous
medialisation

Authors

A. Makulavicius
X. Martin Oliva
G. Mazarevicius
M. Klinga
V. Uvarovas
N. Porvaneckas
M. Monzó Planella
T. Mazurek

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