Anatomical research of positional relationship between protective channel and sural nerve during Achilles tendon repair using channel assisted minimally invasive repair technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhonghe ^1,2 , CAO Wenhao ³ , QI Hongzhe ³ , KONG Lingtong ³ , LIU Haoyu ³ , CHEN Chen ² , LI Lianhua ³ , SUN Lijun ³ ,  CHEN Hua ^1,2,3

1. Graduate School, Ningxia Medical University, Yinchuan Ningxia, 750004, P. R. China;
2. Orthopedic Department Unit 1, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P. R. China;
3. Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100142, P. R. China;

Corresponding author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Acute Achilles tendon rupture; channel assisted minimally invasive repair technique; sural nerve injury; cadaveric study

DOI：

10.7507/1002-1892.202408055

Video：

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Objective To evaluate the positional relationship between protective channel and sural nerve while treating acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique based on anatomical observations of cadaver specimens. Methods Twelve adult cadaveric lower limb specimens (6 left, 6 right) were utilized. A CAMIR device was implanted at a distance of 4 cm from the proximal end of the specimen to the Achilles tendon insertion. The skin was incised along the tendon’s medial side, the sural nerve was dissected, and the positional relationship with the protective channel was observed. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion, the vertical distance between protective channel and the calcaneal insertion, and the horizontal distance between the sural nerve and protective channel were measured by using vernier caliper. Results Anatomical examination demonstrated a variable positional relationship between the sural nerve and protective channel, with the sural nerve positioned above (8 specimens) or below (4 specimens) the protective channel. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion was (105.67±14.94) mm, the vertical distance between protective channel and the calcaneal insertion was (93.20±9.57) mm, and the horizontal distance between the sural nerve and protective channel was (0.31±0.14) mm. Conclusion The use of CAMIR technique for the treatment of acute Achilles tendon rupture can effectively avoid iatrogenic injury to the sural nerve.

Citation： WANG Zhonghe, CAO Wenhao, QI Hongzhe, KONG Lingtong, LIU Haoyu, CHEN Chen, LI Lianhua, SUN Lijun, CHEN Hua. Anatomical research of positional relationship between protective channel and sural nerve during Achilles tendon repair using channel assisted minimally invasive repair technique. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(11): 1325-1329. doi: 10.7507/1002-1892.202408055 Copy

1.	Järvinen TA, Kannus P, Maffulli N, et al. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin, 2005, 10(2): 255-266.
2.	Lantto I, Heikkinen J, Flinkkila T, et al. A prospective randomized trial comparing surgical and nonsurgical treatments of acute achilles tendon ruptures. Am J Sports Med, 2016, 44(9): 2406-2414.
3.	Attia A K, Mahmoud K, D’Hooghe P, et al. Outcomes and complications of open versus minimally invasive repair of acute achilles tendon ruptures: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med, 2023, 51(3): 825-836.
4.	Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. British Medical Bulletin, 2014, 109(1): 45-54.
5.	Appy-Fedida B, Vernois J, Krief E, et al. Risk of sural nerve injury during lateral distal Achilles tendinoscopy: A cadaver study. Orthop Traumatol Surg Res, 2015, 101(1): 93-96.
6.	Tan ACK, Tang ZH, Fadil MFBM. Cadaveric anatomical study of sural nerve: Where is the safe area for endoscopic gastrocnemius recession? Open Orthop J, 2017, 11: 1094-1098.
7.	Lacoste S, Féron JM, Cherrier B. Percutaneous Tenolig (^®) repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture. Orthop Traumatol Surg Res, 2014, 100(8): 925-930.
8.	Doral MN, Alam M, Bozkurt M, et al. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 638-643.
9.	Ruiz-Riquelme P, Poggio-Cano D, Sala-Blanch X, et al. Ultrasound evaluation of a new surface reference line to describe sural nerve location and safe zones to consider in posterior leg approaches. Knee Surg Sports Traumatol Arthrosc, 2023, 31(6): 2216-2225.
10.	Cross AG, Khalil LS, Tomlinson M, et al. Percutaneous Achilles tendon repair using ultrasound guidance: An intraoperative ultrasound technique. Arthrosc Tech, 2023, 12(2): e173-e180.
11.	王瑞强, 武英楷, 苏长辉, 等. 术中超声辅助微创修复急性跟腱断裂. 中国矫形外科杂志, 2022, 30(19): 1816-1819.
12.	Chen H, Ji X, Zhang Q, et al. Channel-assisted minimally invasive repair of acute Achilles tendon rupture. J Orthop Surg Res, 2015, 10(1): 167. doi: 10.1186/s13018-015-0310-9.
13.	吴韬光, 陈华, 聂少波, 等. 完全清醒无止血带局部麻醉技术在治疗急性跟腱断裂中的应用. 中国修复重建外科杂志, 2022, 36(3): 279-283.
14.	齐红哲, 朱正国, 常祖豪, 等. 通道辅助微创缝合与两种常用跟腱缝合方式的生物力学研究. 现代生物医学进展, 2017, 17(18): 3477-3480.
15.	Li Y, Jiang Q, Chen H, et al. Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture. BMC Musculoskelet Disord, 2021, 22(1): 914. doi: 10.1186/s12891-021-04802-8.
16.	McGee R, Watson T, Eudy A, et al. Anatomic relationship of the sural nerve when performing Achilles tendon repair using the percutaneous Achilles repair system, a cadaveric study. Foot Ankle Surg, 2020, 27(4): 427-431.
17.	Zappia M, Berritto D, Oliva F, et al. High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon. Foot Ankle Surg, 2018, 24(4): 342-346.
18.	Apaydin N, Bozkurt M, Loukas M, et al. Relationships of the sural nerve with the calcaneal tendon: an anatomical study with surgical and clinical implications. Surg Radiol Anatomy, 2009, 31(10): 775-780.
19.	Blackmon JA, Atsas S, Clarkson MJ, et al. Locating the sural nerve during calcaneal (Achilles) tendon repair with confidence: a cadaveric study with clinical applications. J Foot Ankle Surg, 2013, 52(1): 42-47.
20.	Porter KJ, Robati S, Karia P, et al. An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device. Foot Ankle Surg, 2014, 20(2): 90-93.
21.	Yammine K, Honeine MO, Alam AE, et al. Locating the danger zone to avoid injury to the sural nerve during Achilles calcaneal tendon repair. A systematic review of cadaveric studies with clinical implications. Surg Radiol Anat, 2022, 44(8): 1131-1138.

1. Järvinen TA, Kannus P, Maffulli N, et al. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin, 2005, 10(2): 255-266.
2. Lantto I, Heikkinen J, Flinkkila T, et al. A prospective randomized trial comparing surgical and nonsurgical treatments of acute achilles tendon ruptures. Am J Sports Med, 2016, 44(9): 2406-2414.
3. Attia A K, Mahmoud K, D’Hooghe P, et al. Outcomes and complications of open versus minimally invasive repair of acute achilles tendon ruptures: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med, 2023, 51(3): 825-836.
4. Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. British Medical Bulletin, 2014, 109(1): 45-54.
5. Appy-Fedida B, Vernois J, Krief E, et al. Risk of sural nerve injury during lateral distal Achilles tendinoscopy: A cadaver study. Orthop Traumatol Surg Res, 2015, 101(1): 93-96.
6. Tan ACK, Tang ZH, Fadil MFBM. Cadaveric anatomical study of sural nerve: Where is the safe area for endoscopic gastrocnemius recession? Open Orthop J, 2017, 11: 1094-1098.
7. Lacoste S, Féron JM, Cherrier B. Percutaneous Tenolig (^®) repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture. Orthop Traumatol Surg Res, 2014, 100(8): 925-930.
8. Doral MN, Alam M, Bozkurt M, et al. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 638-643.
9. Ruiz-Riquelme P, Poggio-Cano D, Sala-Blanch X, et al. Ultrasound evaluation of a new surface reference line to describe sural nerve location and safe zones to consider in posterior leg approaches. Knee Surg Sports Traumatol Arthrosc, 2023, 31(6): 2216-2225.
10. Cross AG, Khalil LS, Tomlinson M, et al. Percutaneous Achilles tendon repair using ultrasound guidance: An intraoperative ultrasound technique. Arthrosc Tech, 2023, 12(2): e173-e180.
11. 王瑞强, 武英楷, 苏长辉, 等. 术中超声辅助微创修复急性跟腱断裂. 中国矫形外科杂志, 2022, 30(19): 1816-1819.
12. Chen H, Ji X, Zhang Q, et al. Channel-assisted minimally invasive repair of acute Achilles tendon rupture. J Orthop Surg Res, 2015, 10(1): 167. doi: 10.1186/s13018-015-0310-9.
13. 吴韬光, 陈华, 聂少波, 等. 完全清醒无止血带局部麻醉技术在治疗急性跟腱断裂中的应用. 中国修复重建外科杂志, 2022, 36(3): 279-283.
14. 齐红哲, 朱正国, 常祖豪, 等. 通道辅助微创缝合与两种常用跟腱缝合方式的生物力学研究. 现代生物医学进展, 2017, 17(18): 3477-3480.
15. Li Y, Jiang Q, Chen H, et al. Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture. BMC Musculoskelet Disord, 2021, 22(1): 914. doi: 10.1186/s12891-021-04802-8.
16. McGee R, Watson T, Eudy A, et al. Anatomic relationship of the sural nerve when performing Achilles tendon repair using the percutaneous Achilles repair system, a cadaveric study. Foot Ankle Surg, 2020, 27(4): 427-431.
17. Zappia M, Berritto D, Oliva F, et al. High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon. Foot Ankle Surg, 2018, 24(4): 342-346.
18. Apaydin N, Bozkurt M, Loukas M, et al. Relationships of the sural nerve with the calcaneal tendon: an anatomical study with surgical and clinical implications. Surg Radiol Anatomy, 2009, 31(10): 775-780.
19. Blackmon JA, Atsas S, Clarkson MJ, et al. Locating the sural nerve during calcaneal (Achilles) tendon repair with confidence: a cadaveric study with clinical applications. J Foot Ankle Surg, 2013, 52(1): 42-47.
20. Porter KJ, Robati S, Karia P, et al. An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device. Foot Ankle Surg, 2014, 20(2): 90-93.
21. Yammine K, Honeine MO, Alam AE, et al. Locating the danger zone to avoid injury to the sural nerve during Achilles calcaneal tendon repair. A systematic review of cadaveric studies with clinical implications. Surg Radiol Anat, 2022, 44(8): 1131-1138.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical research of positional relationship between protective channel and sural nerve during Achilles tendon repair using channel assisted minimally invasive repair technique

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