Arthroscopic versus ultrasonography-assisted achilles tendon repair

Abstract

Introduction: Achilles tendon rupture constitutes 40% of all operated tendon ruptures. Non-operative treatment results in 8-18% of tendon’s re-rupture, compared to 1-4% in the operative treatment. Percutaneous repair is a blind repair, where malalignment of the stumps results in a higher re-rupture rate and decreased strength of the repaired site than the open repair. Arthroscopy and ultrasound are used for minimally invasive surgical repair of the Achilles tendon ruptures. Aim: To compare the results of the Achilles tendon repair between arthroscopic assistance and ultrasound guidance. Methods: Thirty patients 28 to 46 years old were operated on for Achilles tendon rupture. Half of them underwent an arthroscopic assisted percutaneous repair and the rest an ultrasound-assisted percutaneous repair. Sutures in the arthroscopic group were passed through the tendon’s end under direct vision, whereas the sutures in the ultrasound group were passed with the aid of ultrasound. The foot immobilized with a cast for two weeks followed by a full weight-bearing removable cast for another 4 weeks, and then the patient wore an insole wedge pad underneath the heel for an extra 3 months. Both methods were evaluated using the heel raise test. Results: All patients showed an excellent outcome according to the heel-raise test. However, the results did not show any statistically significant differences between the outcomes of the ultrasound-assisted and the arthroscopic group. Conclusions: Both techniques revealed similar positive outcomes. However, ultrasonography showed a better identification of the suture, minimized the sural nerve’s injuries, and offered an overview of the gap when closing.