title: The rate of sural nerve violation using the Achillon device: a cadaveric study.
abstract: BACKGROUND
  Management of acute Achilles tendon rupture remains controversial. Open repair results in lower rerupture rates but is associated with complications from wound healing. Percutaneous and limited open repairs minimize soft tissue complications; however, there is a theoretical increased risk of sural nerve injury. We evaluated the risk of sural nerve violation with the Achillon limited open repair device in cadavers.
  
  
  METHODS
  This cadaveric study consisted of 2 parts. The first part evaluated the frequency and location of sural nerve violation using the standard Achillon protocol in 18 intact embalmed left lower limbs. The second part involved device manipulation with 30 degrees of either internal or external rotation in 13 paired, intact embalmed lower limbs.
  
  
  RESULTS
  In the first part, 5 of 18 specimens had at least 1 suture passing through the sural nerve. Eight of the 54 needle passes (14.8%) directly pierced the substance of the sural nerve. With internal rotation, 8 of 13 specimens had at least 1 violation of the nerve. Ten of the 39 needle passes (25.6%) directly pierced the substance of the sural nerve. With external rotation, no nerves were violated, significantly decreasing the risk of sural nerve violation versus neutral (P = .038) and internal rotation (P = .001). When sural nerve violation was evaluated in regard to instrument outlet, there was a higher risk in the proximal needle passer (outlet no. 3) compared with the distal needle passer (outlet no. 1) with both neutral testing and internal rotation (P = .027).
  
  
  CONCLUSIONS
  This study demonstrated the potential risk for sural nerve injury using the Achillon device.
  
  
  CONCLUSIONS
  External rotation of the Achillon decreased the rate of sural nerve violation. This may optimize its use in Achilles tendon repairs.
authors.affiliation: SUNY Downstate Medical Center Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY 11203, USA. william.aibinder@downstate.edu
authors.forename: William R
authors.initials: WR
authors.lastname: Aibinder
authors.forename: Ashish
authors.initials: A
authors.lastname: Patel
authors.forename: Johnny
authors.initials: J
authors.lastname: Arnouk
authors.forename: Hebah
authors.initials: H
authors.lastname: El-Gendi
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Korshunov
authors.forename: Joshua
authors.initials: J
authors.lastname: Mitgang
authors.forename: Jaime
authors.initials: J
authors.lastname: Uribe
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D002102:Cadaver; D006801:Humans; D013497:Sural Nerve / Q000033:anatomy & histology / Q000293:injuries*; D013525:Surgical Instruments / Q000009:adverse effects*; D013537:Sutures
keywords: Achilles tendon rupture; Achillon; limited open repair; sural nerve