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Percutaneous Achilles Tendon Repair

March 01, 2019

Contributors: Kevin R Stone, MD; Kevin R Stone, MD

Percutaneous suture repair is effective for the treatment of patients with a soft-tissue rupture, such as an Achilles tendon rupture, who have the goal of returning to sports activity. In this video, Dr. Kevin R. Stone demonstrates percutaneous Achilles tendon repair in a 26-year-old man with a ruptured right Achilles tendon. The goal of percutaneous Achilles tendon repair is to capture the proximal fibers and approximate them against the distal fibers while preserving the natural clot and not disrupting the Achilles tendon sheath. The posterior ankle is palpated to locate the proximal and distal fibers and the location of the defect before injecting a local anesthetic agent. A small incision is made on the medial side of the proximal tendon, and a resorbable suture is horizontally passed through the proximal tendon. A small incision is made where the needle will emerge, and the suture is pulled through. The suture is passed back through the tendon at an inferior angle, using a scalpel to create an exit portal. This process is repeated multiple times, crossing the defect and the distal segment of the Achilles tendon. Tension is then applied to the suture to pull the proximal and distal pieces of the tendon together, and the suture knot is tied on the medial side to prevent sural nerve entrapment. A second suture is passed through the same incisions and tied medially. Amniotic stem cells and growth factors or platelet-rich plasma are then injected to stimulate and accelerate healing. Long-term data demonstrate tendon healing, with a normal yet slightly thicker than usual Achilles tendon observed on MRI.