Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases.

Ma and Griffith first described in 1977 a percutaneous technique for the repair of acute Achilles tendon rupture. In 1992, Delponte popularised a new percutaneous technique with Tenolig. The authors report a series of 124 cases of Achilles tendon rupture treated with Tenolig in their institution from 1993 to 1998. There were 79 men and 45 women. The mean age was 41.5 years, with a peak from 30 to 39 years. The rupture occurred during sports activities in 69 cases. The mean duration of follow-up was 1.9 years. Surgical complications noted were: unbending of one of the harpoon wires in 5 cases, rupture of the harpoon wire in one case and tendon re-rupture in 12 cases. The rate of re-rupture was similar to the rate noted with conservative treatment (10%). Skin necrosis at the entrance wound was noted in 10 cases, and injury of the sural nerve in 8 cases. Full weight-bearing without crutches was regained for 95% of patients within 3 months. In conclusion, this report shows a high rate of re-rupture and sural nerve entrapment with percutaneous surgery (Tenolig). The high rate of re-rupture can be due to the progressive but immediate weight-bearing allowed without an orthosis, or to inadequate apposition of the tendon ends, or to delay before repair. The high rate of sural nerve entrapment is due to its proximity to the Achilles tendon. We believe that a limited open technique is more reliable and has the advantage of allowing direct visualisation of the repair site and controlling adequate apposition of the tendon ends.