Achilles tendon rupture: Integra Achillon percutaneous repair
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Operative repair of the acutely ruptured Achilles tendon allows controlled apposition of the tendon ends and restoration of the normal length of the triceps surae musculo-tendinous unit.
This may be the preferred method of treatment in active patients and in those patients where the gap between the tendon ends does not close sufficiently with the ankle placed into maximal plantar-flexion (as assessed on a pre-operative ultrasound scan).
The Integra Achillon limited open repair technique permits direct visualisation and apposition of the ruptured Achilles tendon ends whilst limiting the extent of the soft tissue dissection. It has the benefit of using a much smaller incision than conventional open repair techniques which probably provides advantage with respect to superficial wound complications. It also has the benefit of being one of the systems with the longest track-record for minimally invasive Achilles repair.
The published results using the Integra Achillon emphasise the need for careful execution of technique and in particular placement of the Achillon jig between the discreetly dissected layers of the fascia cruris and paratenon to minimise the chance of Sural nerve injury. The key papers to be read are: Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. Assal M et al. JBJS (Am) 2002; 84: 161-70, Early, active rehabilitation following mini-open repair of Achilles tendon rupture: a prospective study. Calder JD, Saxby TS. Br J Sports Med 2005; 39: 857-9 and Outcome following use of the Achillon jig for the repair of acutely ruptured Achilles tendons. Davies H, Agrawal Y, Blundell C, Davies MB. Injury 2017; 48: 781-3.
Author: Mark Davies FRCS (Tr & Orth)
Institution: The Northern General Hospital, Sheffield ,UK.