Total Sports Medicine and Orthopedics, 10105 Banburry Cross Drive, Las Vegas, NV, 89144, United States; Valley Hospital Medical Center, Department of Orthopedic Surgery, 620 Shadow Lane, Las Vegas, NV, 89106, United States.
Valley Hospital Medical Center, Department of Orthopedic Surgery, 620 Shadow Lane, Las Vegas, NV, 89106, United States; Desert Orthopaedic Center, 2800 East Desert Inn Road, Las Vegas, NV, 89121, United States.
Foot Ankle Surg. 2021 Jun;27(4):427-431. doi: 10.1016/j.fas.2020.05.011. Epub 2020 Jun 7.
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.
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.
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.
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.
微创技术用于跟腱修复的应用越来越多，这是因为采用切开和经皮技术修复跟腱时，报告显示其再断裂率相似，但经皮技术的伤口并发症更少，康复更快。本研究的目的是通过记录穿过的针与腓肠神经之间的距离，以及在移除导向器后，确定针是否直接损伤神经或神经被缝线困在跟腱内，从而定量研究在使用经皮跟腱修复系统（PARS）（Arthrex，佛罗里达州那不勒斯）时腓肠神经损伤的关系和风险。该研究的假设是，PARS 技术可以安全地进行，而不会对腓肠神经造成重大损伤。
在模拟跟腱中段断裂后，在 10 个下肢尸体标本的每个标本中使用近端部分通过 PARS 导向器放置 5 根针。仔细解剖以测量腓肠神经与穿过的针之间的距离。然后，当导向器从跟腱近端移除时，通过切口拔出缝线，并记录缝线与跟腱的关系。
在 10 个尸体标本中，没有一个标本的腓肠神经受到侵犯。50 根针中没有一根直接刺穿腓肠神经。此外，当拔出导向器时，所有缝线都被注意到位于腱鞘内，没有发现腓肠神经被困。
本研究表明腓肠神经的走行多变，并确定了使用 PARS 修复跟腱时腓肠神经损伤的潜在风险。然而，本研究从解剖学角度提供了额外的安全性证据，解释了临床试验中所展示的结果。有了这些信息，作者相信外科医生在正确使用该技术时，可以放心地复制这些结果，同时最大限度地降低腓肠神经损伤的风险。
