Endoscopy and percutaneous suturing in the achilles tendon ruptures

Achilles tendon ruptures commonly occur during sportive activities and there is a tendency of increasing in the incidence of ruptures because of “weekend warriors” who are over 30 years of age. These pathologies are the third most frequent major tendon ruptures after rotator cuff and quadriceps ruptures. Various modalities have been recommended as appropriate treatment options for Achilles tendon ruptures. Nevertheless, there is no consensus on the treatment method, and it is still determined by the surgeon and the patient. Open surgical repair of the Achilles tendon carries specific risks including adhesions between the tendon and the skin, infection, and particularly wound breakdown. Therefore, to avoid these complications the percutaneous repair technique has been described and has become popular. Endoscopy-assisted percutaneous suturing of the Achilles tendon under infiltration anesthesia proffers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique resulted in a cosmetic wound appearance, endurable to early active mobilization and satisfactory clinical recovery without any severe complication. Furthermore, this procedure protects the paratenon and thus blood supplies of the tendon, and enhances biologic recovery. Also direct visualization and manipulation of the tendon ends provides a precise apposition of the ruptured tendon, thus diminishing the handicaps of the single percutaneous technique. In this chapter we described our Achilles tendon repair technique under local anesthesia without tourniquet and with cooperation of the patient, and the results of our clinical experiences under the lights of literature. © Springer-Verlag Berlin Heidelberg 2012