title: Minimally Invasive Approach to Achilles Tendon Pathology.
abstract: Many surgical procedures have been described for Achilles tendon pathology; however, no overwhelming consensus has been reached for surgical treatment. Open repair using a central or paramedian incision allows excellent visualization for end-to-end anastomosis in the case of a complete rupture and detachment and reattachment for insertional pathologies. Postoperative wound dehiscence and infection in the Achilles tendon have considerable deleterious effects on overall functional recovery and outcome and sometimes require plastic surgery techniques to achieve coverage. With the aim of avoiding such complications, foot and ankle surgeons have studied less invasive techniques for repair. We describe a percutaneous approach to Achilles tendinopathy using a modification of the Bunnell suture weave technique combined with the use of interference screws. No direct end-to-end repair of the tendon is performed, rather, the proximal stump is brought in direct proximity of the distal stump, preventing overlengthening and proximal stump retraction. This technique also reduces the suture creep often seen with end-to-end tendon repair by providing a direct, rigid suture to bone interface. We have used the new technique to minimize dissection and exposure while restoring function and accelerating recovery postoperatively.
authors.affiliation: Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Hegewald
authors.affiliation: Third Year Podiatric Medical Student, California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA. Electronic address: doyle.matt14@gmail.com.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Doyle
authors.affiliation: Attending Foot and Ankle Surgeon, Palo Alto Medical Foundation, Mountain View, CA.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Todd
authors.affiliation: Fellowship Director, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rush
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D016512:Ankle Injuries / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D012421:Rupture; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery*
keywords: Achilles tendon; Bunnell suture; percutaneous; surgical technique; trauma