Endoscopic-assisted repair of acute Achilles tendon rupture with Krackow suture: an anatomic study.
OBJECTIVE
To study the feasibility of applying Krackow locking stitches in the endoscopic-assisted repair of acute Achilles tendon rupture and the possible complications encountered.


METHODS
Anatomic study.


METHODS
Twelve Achilles tendons in six cadavers were cut at 6cm from its insertion and endoscopic-assisted repair of Achilles tendon was performed. These legs were then cut open in midline to study (i) the locking stitches formed and (ii) the relation of the sural nerve to the locking stitches.


RESULTS
With endoscopic-assisted technique, Krackow-type locking stitches can be formed in eight legs. In four legs, the stitches fell into the ruptured gap and lie deep to the tendon. The tendon rupture end was grasped by the suture rather than forming a Krackow-type locking stitch when the suture was tightened. There was no sural nerve laceration noted. However, in two legs, the sural nerves were found trapped in the sutures at around the proximal portal.


CONCLUSIONS
Krackow locking stitches can be formed by the minimally invasive technique. However, there are risks of stitches falling into the ruptured gap and lie deep to the tendon and risk of sural nerve entrapment at the proximal medial portal. The original technique is not suitable for clinical application. Modification of the technique by grasping the tendon end with Allis tissue forceps before passing the suture may prevent the suture from falling into the ruptured tendon gap.
Chan
K B
KB
Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China.
Lui
T H
TH
Chan
L K
LK
D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000473:pathology / Q000601:surgery*; D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D012421:Rupture; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures