Anatomic relationship of the sural nerve when performing Achilles tendon repair using the percutaneous Achilles repair system, a cadaveric study.
Achilles Tendon
/ anatomy & histology
Aged
Aged, 80 and over
Cadaver
Female
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
/ adverse effects
Nerve Compression Syndromes
/ etiology
Rupture
/ surgery
Sural Nerve
/ anatomy & histology
Suture Techniques
Sutures
Tendon Injuries
/ surgery
Treatment Outcome
Achilles
Injury
Percutaneous
Repair
Rupture
Sports
Tendon
Trauma
Journal
Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons
ISSN: 1460-9584
Titre abrégé: Foot Ankle Surg
Pays: France
ID NLM: 9609647
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
09
02
2020
revised:
14
05
2020
accepted:
23
05
2020
pubmed:
20
6
2020
medline:
8
7
2021
entrez:
20
6
2020
Statut:
ppublish
Résumé
Minimally invasive techniques for Achilles tendon repair are increasing due to reports of similar rerupture rates using open and percutaneous techniques with fewer wound complications and quicker recovery with percutaneous methods. The goal of this study was to investigate quantitatively the relationship and risk of injury to the sural nerve during Achilles tendon repair when using the Percutaneous Achilles Repair System (PARS) (Arthrex®, Naples, FL), by recording the distance between the passed needles and the sural nerve as well identifying any direct violation of the nerve with needle passage or nerve entrapment within the suture after the jig was removed. The hypothesis of the study is that the PARS technique can be performed safely and without significant risk of injury to the sural nerve. A total of five needles were placed through the PARS jig in each of 10 lower extremity cadaveric specimens using the proximal portion after simulation of a midsubstance Achilles tendon rupture. Careful dissection was performed to measure the distance of the sural nerve in relation to the passed needles. The sutures were then pulled out through the incision as the jig was removed from the proximal portion of the tendon and observation of the suture in relation to the tendon was documented. Of the 10 cadaveric specimens, none had violation of the sural nerve. Zero of the 50 (0%) needles directly punctured the sural nerve. In addition, upon retraction of the jig, all sutures were noted to reside within the tendon sheath with no entrapment of the sural nerve noted. This study demonstrated the variable course of the sural nerve and identifies the potential risk for sural nerve injury when using the PARS for Achilles tendon repair. However, this study provides additional evidence of safety from an anatomic standpoint that explains the outcomes demonstrated in the clinical trials. With this information the authors believe surgeons should feel comfortable they can replicate those outcomes while minimizing risk of sural nerve injury when the technique is used correctly.
Sections du résumé
BACKGROUND
BACKGROUND
Minimally invasive techniques for Achilles tendon repair are increasing due to reports of similar rerupture rates using open and percutaneous techniques with fewer wound complications and quicker recovery with percutaneous methods. The goal of this study was to investigate quantitatively the relationship and risk of injury to the sural nerve during Achilles tendon repair when using the Percutaneous Achilles Repair System (PARS) (Arthrex®, Naples, FL), by recording the distance between the passed needles and the sural nerve as well identifying any direct violation of the nerve with needle passage or nerve entrapment within the suture after the jig was removed. The hypothesis of the study is that the PARS technique can be performed safely and without significant risk of injury to the sural nerve.
METHODS
METHODS
A total of five needles were placed through the PARS jig in each of 10 lower extremity cadaveric specimens using the proximal portion after simulation of a midsubstance Achilles tendon rupture. Careful dissection was performed to measure the distance of the sural nerve in relation to the passed needles. The sutures were then pulled out through the incision as the jig was removed from the proximal portion of the tendon and observation of the suture in relation to the tendon was documented.
RESULTS
RESULTS
Of the 10 cadaveric specimens, none had violation of the sural nerve. Zero of the 50 (0%) needles directly punctured the sural nerve. In addition, upon retraction of the jig, all sutures were noted to reside within the tendon sheath with no entrapment of the sural nerve noted.
CONCLUSION
CONCLUSIONS
This study demonstrated the variable course of the sural nerve and identifies the potential risk for sural nerve injury when using the PARS for Achilles tendon repair. However, this study provides additional evidence of safety from an anatomic standpoint that explains the outcomes demonstrated in the clinical trials. With this information the authors believe surgeons should feel comfortable they can replicate those outcomes while minimizing risk of sural nerve injury when the technique is used correctly.
Identifiants
pubmed: 32553425
pii: S1268-7731(20)30104-1
doi: 10.1016/j.fas.2020.05.011
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
427-431Informations de copyright
Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.