Limited Open Repair of Achilles Tendon Ruptures by Mathieu Assal, Maximilien Jung, Richard Stern, Pascal Rippstein, Marino Delmi, and Pierre Hoffmeyer.

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Presentation transcript:

Limited Open Repair of Achilles Tendon Ruptures by Mathieu Assal, Maximilien Jung, Richard Stern, Pascal Rippstein, Marino Delmi, and Pierre Hoffmeyer J Bone Joint Surg Am Volume 84(2): February 1, 2002 ©2002 by The Journal of Bone and Joint Surgery, Inc.

The guiding instrument, with a straight needle and suture passed through one of the levels of holes. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The instrument has been introduced into the cadaver leg, and three sutures have been placed percutaneously, through the branches of the instrument, into the proximal part of the tendon. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The cadaver leg has been dissected to observe the instrument, the Achilles tendon and tendon sheath, and the sural nerve. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The skin incision is begun just medial to the gap or soft spot in the tendon and extended 1.5 to 2 cm proximally. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The sheath is opened longitudinally in the midline, and a stay suture is placed. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The forceps grasp the proximal tendon stump. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The instrument is introduced under the paratenon. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The first needle is introduced. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

All three sutures are in the proximal part of the tendon. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The instrument is being withdrawn, bringing the sutures from an extracutaneous position to a peritendinous position. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The sutures are organized for tightening. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

The tendon is reduced under direct vision, confirming apposition of the tendon ends. Mathieu Assal et al. J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.