Acute Achilles Tendon Rupture, A More Cost-Effective Surgical Technique Option: Dresden-Calcaneal Tunnel

CATEGORY: Sports; Ankle INTRODUCTION/PURPOSE: Surgical treatment remains the standard of care for active patients with acute midsubstance Achilles tendon ruptures. Clinical decisions must be made, often under circumstances of limited resources. The objective of our study was to describe a reduced cost minimally invasive surgical technique. The use of suture anchor increases the tensile strength of the repair, allowing to prevent tendon lengthening and re-ruptures during early rehabilitation, but these present a high cost and are not exempt from complications such as pullout, local irritation and bone edema. A simple and low-cost alternative that allows us to replace the function of the anchors is to drill a bone tunnel in the calcaneus and pass a high-resistance suture through it. METHODS: After obtaining IRB approval, a retrospective review of 12 patients with acute Achilles tendon rupture treated with the modified Dresden-Calcaneal Tunnel technique, between January 2019 and August 2020 and followed up for 6 months. Clinical outcome was assessed using the AOFAS, FAOS and SF-36 scores. Complications, and time to return to work and light sport activity were assessed. RESULTS: The AOFAS score was 94 +/- 5, FAOS 95% +/- 2 and SF-36 92 +/- 4 at 6 months postoperatively. The recovery time of the patients was 10-18 weeks. The postoperative recovery time to exercise was 16-24 weeks. There was only 2 cases with discomfort in relation to the suture knot near to the calcaneal tunnel, but both case refers spontaneous relief at the second month postoperative. CONCLUSION: This new and minimally invasive technique could be a more cost-effective option in the management of acute Achilles tendon rupture with good functional outcomes. These strategy presents a low occurrence of complications, permit a strong fixation, avoid sural nerve entrapment and respect the biologic environment.