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

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

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

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.

中文翻译：

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使用经皮跟腱修复系统进行跟腱修复时腓肠神经的解剖关系，尸体研究

背景

跟腱修复的微创技术正在增加，因为有报道称使用开放和经皮技术具有相似的再破裂率，伤口并发症更少，经皮方法恢复更快。本研究的目的是在使用经皮跟腱修复系统 (PARS) (Arthrex®, Naples, FL) 时，通过记录通过的针之间的距离，定量研究跟腱修复过程中腓肠神经损伤的关系和风险和腓肠神经以及在移除夹具后识别任何直接侵犯神经的针通道或缝合线内的神经卡压。该研究的假设是，PARS 技术可以安全地进行，并且不会对腓肠神经造成显着的损伤。

方法

在模拟中质跟腱断裂后，使用近端部分通过 PARS 夹具在 10 个下肢尸体标本中的每一个中放置总共五根针。仔细解剖以测量腓肠神经相对于通过的针的距离。当夹具从肌腱的近端部分移除时，然后将缝合线通过切口拉出，并记录与肌腱相关的缝合线的观察。

结果

在 10 个尸体标本中，没有一个侵犯腓肠神经。50 (0%) 根针中的零根直接刺穿了腓肠神经。此外，在夹具缩回时，注意到所有缝合线都位于腱鞘内，没有注意到腓肠神经被卡住。

结论

这项研究证明了腓肠神经的可变路线，并确定了使用 PARS 进行跟腱修复时腓肠神经损伤的潜在风险。然而，这项研究从解剖学的角度提供了额外的安全性证据，解释了临床试验中证明的结果。有了这些信息，作者认为外科医生应该感到舒服，他们可以复制这些结果，同时在正确使用该技术时将腓肠神经损伤的风险降至最低。