Endoscopy and percutaneous suturing in the achilles tendon ruptures and proprioceptive physiotherapy

Abstract

Achilles tendon ruptures commonly occur during sports activities and there is an increasing tendency in the incidence of these ruptures due to ‘weekend warriors' who are over 30 years of age. Achilles tendon ruptures 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; however, there is no consensus on the treatment method, which is still determined by the surgeon and patient. Open surgical repair of the Achilles tendon carries specific risks, including adhesions between the tendon and the skin, infection and, in particular, wound breakdown. Thus, 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 offers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique results in acceptable wound appearance that is able to endure early active mobilization and satisfactory clinical recovery without any severe complications. 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 the authors describe their own Achilles tendon repair technique under local anesthesia without a tourniquet and with cooperation of the patient, and the results of their clinical experiences as well as those in the literature. © Springer-Verlag Berlin Heidelberg 2012, 2015, All Rights Reserved.