Endoscopic-assisted repair of acute Achilles tendon rupture with Krackow suture: An anatomic study
Received 17 September 2008; received in revised form 31 January 2009; accepted 13 February 2009. published online 07 April 2009.
Abstract
Purpose
To study the feasibility of applying Krackow locking stitches in the endoscopic-assisted repair of acute Achilles tendon rupture and the possible complications encountered.
Type of study
Anatomic study.
Methods
Twelve Achilles tendons in six cadavers were cut at 6cm from its insertion and endoscopic-assisted repair of Achilles tendon was performed. These legs were then cut open in midline to study (i) the locking stitches formed and (ii) the relation of the sural nerve to the locking stitches.
Result
With endoscopic-assisted technique, Krackow-type locking stitches can be formed in eight legs. In four legs, the stitches fell into the ruptured gap and lie deep to the tendon. The tendon rupture end was grasped by the suture rather than forming a Krackow-type locking stitch when the suture was tightened. There was no sural nerve laceration noted. However, in two legs, the sural nerves were found trapped in the sutures at around the proximal portal.
Conclusions
Krackow locking stitches can be formed by the minimally invasive technique. However, there are risks of stitches falling into the ruptured gap and lie deep to the tendon and risk of sural nerve entrapment at the proximal medial portal. The original technique is not suitable for clinical application. Modification of the technique by grasping the tendon end with Allis tissue forceps before passing the suture may prevent the suture from falling into the ruptured tendon gap.
aDepartment of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China
bInstitute of Medical and Health Sciences Education and Department of Anatomy, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China
ABSTRACT