Sural nerve injury after repair of a ruptured Achilles tendon: Case report and literature review

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.

Download Full-text

Partial Achilles Tendon Ruptures Associated with Fluoroquinolone Antibiotics: A Case Report and Literature Review

Foot & Ankle International ◽

10.1177/107110079601700811 ◽

1996 ◽

Vol 17 (8) ◽

pp. 496-498 ◽

Cited By ~ 62

Author(s):

William C. McGarvey ◽

Dishan Singh ◽

Saul G. Trevino

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Magnetic Resonance ◽

Literature Review ◽

Achilles Tendon ◽

Tendon Rupture ◽

Resonance Imaging ◽

Achilles Tendinitis ◽

Fluoroquinolone Antibiotics ◽

Tendon Ruptures

Fluoroquinolone antibiotics (such as ciprofloxacin, pefloxacin, ofloxacin, norfloxacin, temafloxacin, etc.) have recently been implicated in the etiology of Achilles tendinitis and subsequent tendon rupture. We report on a patient with bilateral partial Achilles tendon ruptures associated with ciprofloxacin therapy and present a review of the current literature on this increasingly recognized complication. Treatment with fluoroquinolones should be discontinued at the first sign of tendon inflammation so as to reduce the risk of subsequent rupture. Magnetic resonance imaging is useful in distinguishing between Achilles tendinitis and partial tendon rupture.

Download Full-text

Anatomy of the sural nerve and its relation to the Achilles Tendon

Foot & Ankle International ◽

10.1177/107110070002100604 ◽

2000 ◽

Vol 21 (6) ◽

pp. 475-477 ◽

Cited By ~ 142

Author(s):

Jonathan Webb ◽

Narain Moorjani ◽

Mike Radford

Keyword(s):

Achilles Tendon ◽

Nerve Injury ◽

Individual Variation ◽

Sural Nerve ◽

Proximal Part ◽

Lower Limbs ◽

Lateral Border

Sural nerve injury is a complication of Achilles Tendon (TA) rupture. We dissected 30 cadaveric lower limbs to describe the course of the sural nerve in relation to the TA. At the level of insertion of the TA into the calcaneum, the sural nerve was a mean 18.8 mm from the lateral border of the TA. The proximal course of the nerve was towards the midline such that it crossed the lateral border of the TA at a mean distance of 9.8 cm from the calcaneum. The significant individual variation in the position of the sural nerve in relation to the achilles tendon should be borne in mind when placing sutures in the proximal part of the achilles tendon. Percutaneous sutures should not be placed in the lateral half of the TA.

Download Full-text

The use of ultrasonography during minimally invasive Achilles tendon repair to avoid sural nerve injury

Journal of Medical Ultrasonics ◽

10.1007/s10396-019-00951-5 ◽

2019 ◽

Vol 46 (4) ◽

pp. 513-514 ◽

Cited By ~ 1

Author(s):

Joverienne Chavez ◽

Soichi Hattori ◽

Yuki Kato ◽

Shuzo Takazawa ◽

Shin Yamada ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Nerve Injury ◽

Sural Nerve ◽

Tendon Repair ◽

Achilles Tendon Repair

Download Full-text

Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/24730114211060063 ◽

2021 ◽

Vol 6 (4) ◽

pp. 247301142110600

Author(s):

Kristin C. Caolo ◽

Stephanie K. Eble ◽

Carson Rider ◽

Andrew J. Elliott ◽

Constantine A. Demetracopoulos ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Nerve Injury ◽

Sural Nerve ◽

Tendon Repair ◽

Suture Repair ◽

Complication Rates ◽

Achilles Tendon Repair ◽

Patient Reported ◽

Acute Rupture

Background: There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques. Methods: A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry. Demographics and complications were recorded. Results: PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection). Conclusion: Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences. Level of Evidence: Level III, retrospective cohort study.

Download Full-text

Isolated Radial Nerve Injury Following Anterior Shoulder Dislocation: Case Report and Literature Review

Orthopedics and Rheumatology Open Access Journal ◽

10.19080/oroaj.2017.07.555708 ◽

2017 ◽

Vol 7 (2) ◽

Author(s):

Hesham Al-Khateeb

Keyword(s):

Case Report ◽

Literature Review ◽

Nerve Injury ◽

Shoulder Dislocation ◽

Radial Nerve ◽

Anterior Shoulder Dislocation ◽

Radial Nerve Injury

Download Full-text

Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury

Folia Morphologica ◽

10.5603/fm.a2015.0067 ◽

2016 ◽

Vol 75 (1) ◽

pp. 53-59 ◽

Cited By ~ 2

Author(s):

A. Makulavicius ◽

X. Martin Oliva ◽

G. Mazarevicius ◽

M. Klinga ◽

V. Uvarovas ◽

...

Keyword(s):

Achilles Tendon ◽

Nerve Injury ◽

Lower Risk ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Anatomical Study ◽

Positive Effect

Download Full-text

Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

10.21203/rs.3.rs-16380/v2 ◽

2020 ◽

Author(s):

Yongliang Yang ◽

Honglei Jia ◽

Wupeng Zhang ◽

Shihong Xu ◽

Fu Wang ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Nerve Injury ◽

Saphenous Vein ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Intraoperative Ultrasonography ◽

Medial Side ◽

Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV).Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute Achilles Tendon (AT) rupture.

Download Full-text