Repair of distal Achilles tendon rupture and reattachment

Minimally invasive and percutaneous Achilles tendon repair technique allows direct visualization of end-to-end apposition of the ruptured tendon ends whilst minimizing risks of wound breakdown and infection and improving cosmesis. Although they have these advantages, traditional percutaneous repair techniques have been estimated to have half the strength of open repair methods and also present a risk of iatrogenic sural nerve injury. Biomechanical studies have compared box, Bunnell, modified Bunnell, Kessler and Krackow suture configurations in tendon repair models. The mode of failure of percutaneous repair models is the most commonly suture pull out of the distal Achilles stump, at the tendon suture interface. This leads to the separation of the apposed tendon ends and elongation of the healing tendon. In stronger Krackow sutures, with locking loops, failure tends to occur at the suture knots; however, the insertion of these sutures requires greater access and an open repair.