Surgical Repair of the Achilles Tendon using the Three Transverse Incision Technique

Abstract

Category: Sports Introduction/Purpose: Acute rupture of the Achilles tendon is a frequent injury in our country, being the most common rupture of the tendon of the lower limbs( 1 ), especially in men aged between 40-50 years( 2 ). The main complication of the surgical treatment is the care of the soft tissue. To minimize this risk, the technique of three transverse incisions has shown good results and low postoperative complications. We believe that this surgical technique is a good alternative, especially with regard to soft tissue complications. Therefore, the objective of this work is to describe this surgical technique and demonstrate the benefits of its performance, since special materials are not required, and can be performed in any orthopedic service, in addition to the risk of soft tissue involvement. Methods: The proximal and distal stumps are palpated and a demarcation is performed 2 cm proximal to the proximal stump and 2 cm distal to the distal stump. A third demarcation is performed in the center of the gap. The first incision is performed proximally, opening the paratenon and exposing the proximal stump; the suture used is of the Krackow type and Vycril 2 was used. The same procedure is performed on the distal stump. After that, the third incision is made to allow suturing of the extremities and tendon approximation. Procedure performed with the foot in maximum plantar flexion. The planes (paratendon, subcutaneous and skin) are sutured and the limb is immobilized in plantar flexion. The patient remains immobilized in plantar flexion (1 week). The immobilization is exchanged for an orthopedic boot with 4 shims of 1.5 cm each and weight bearing is released with the aid of crutches. Results: Follow-up is performed in the first week for dressing evaluation and in the third week for stitch removal. After that, the patient returns at 6, 12, 24 and 48 weeks after surgery. To date, this technique has been used in 24 patients. There were no re- ruptures, sural nerve neuropraxia/axonotmesis or deep infection. There was 1 case with a superficial infection, which was quickly treated with oral antibiotic therapy. To date, 6 patients have completed the 48-week postoperative follow-up. Conclusion: New studies should be carried out for the best decision on the treatment to be followed in the event of an acute rupture of the Achilles tendon, as well as studies demonstrating, it is hoped, a decrease in the rate of complications with the use of less invasive techniques. Due to the low follow-up (6 patients) we have, it is difficult to make a comparison between the percutaneous and minimally invasive techniques currently described in the literature. documentation of the effectiveness and benefit of this technique.