Minimally Invasive Surgery for Achilles Tendon Disorders in Clinical Practice Nicola Maffulli (cid:129) Mark Easley Editors Minimally Invasive Surgery for Achilles Tendon Disorders in Clinical Practice Editors Nicola Maffulli Mark Easley Mile End Hospital Duke Health Center London Durham United Kingdom North Carolina USA Originally published as part of Minimally Invasive Surgery of the Foot and Ankle (ISBN-978-1-84996-417-3) in 2011. ISBN 978-1-4471-4497-7 ISBN 978-1-4471-4498-4 (eBook) DOI 10.1007/978-1-4471-4498-4 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2012951635 © Springer-Verlag London 2013 This work is subject to copyright. 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Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface The tendo Achillis, the largest and strongest tendon in the body, is the most frequently injured. Overuse and acute injuries plague it, their management is complex, the results not guaran- teed. A few things, however, hold true: there is not much scienti fi c evidence behind what we do, and there is much con- troversy about anything we do in this particular fi eld. Also, the rate of complications of traditional surgery is staggeringly high: in the management of tendinopathy, traditional techniques result in 10 % of patients experiencing a complication related to skin healing. It is therefore not surprising that less invasive techniques have been advocated. In this book, we illustrate the most advanced minimally invasive techniques: they can be hard to master, but they are for the benefi t of the patients. v Contents 1 Endoscopic Assisted Percutaneous Achilles Tendon Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Mahmut Nedim Doral, Murat Bozkurt, Egemen Turhan, and Ozgür Ahmet Atay 2 Percutaneous Repair of Acute Achilles Tendon Ruptures: The Maffulli Procedure. . . . . . . . . 15 Nicola Maffulli, Francesco Oliva, and Mario Ronga 3 Minimally Invasive Semitendinosus Tendon Graft Augmentation for Reconstruction of Chronic Tears of the Achilles Tendon . . . . . . . . . . . 25 Nicola Maffulli, Umile Giuseppe Longo, Filippo Spiezia, and Vincenzo Denaro 4 Minimally Invasive Achilles Tendon Reconstruction Using the Peroneus Brevis Tendon Graft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Nicola Maffulli, Filippo Spiezia, Umile Giuseppe Longo, and Vincenzo Denaro 5 Free Hamstrings Tendon Transfer and Interference Screw Fixation for Less Invasive Reconstruction of Chronic Avulsions of the Achilles Tendon . . . . . . . 45 Nicola Maffulli, Umile Giuseppe Longo, Filippo Spiezia, and Vincenzo Denaro vii viii Contents 6 Percutaneous Longitudinal Tenotomies for Chronic Achilles Tendinopathy . . . . . . . . . . . . . . . . 55 J.S. Young, M.K. Sayana, V. Testa, F. Spiezia, U.G. Longo, and Nicola Maffulli 7 Minimally Invasive Stripping for Chronic Achilles Tendinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Nicola Maffulli, Umile Giuseppe Longo, Chandrusekar Ramamurthy, and Vincenzo Denaro Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Chapter 1 Endoscopic Assisted Percutaneous Achilles Tendon Repair Mahmut N edim Doral, Murat Bozkurt , Egemen Turhan, and Ozgür Ahmet Atay The Achilles tendon is the strongest tendon in the human body [1 ] . Hippocrates said “this tendon, if bruised or cut, causes the most acute fevers, induces choking, deranges the mind and at length brings death” [ 2 ] . Achilles tendon rupture has been the focus of many studies since Ambroise Paré initially M. N. Doral , M.D. ((cid:2)) Department of Orthopedics and Sports Medicine, Faculty of Medicine , Hacettepe University , Sihhiye, Ankara 06100 , Turkey Sports Medicine Department , Hacettepe University , Ankara , Turkey e-mail: [email protected] , [email protected] M. Bozkurt Department of Orthopedics and Traumatology , Ankara Etlik Training Hospital , Ankara , Turkey E. Turhan Department of Orthopedics and Traumatology, Faculty of Medicine , Karaelmas University , Zonguldak , Turkey O. A. Atay Department of Orthopedics and Sports Medicine, Faculty of Medicine , Hacettepe University , Sihhiye, Ankara 06100 , Turkey N. Maffulli, M. Easley (eds.), Minimally Invasive Surgery 1 for Achilles Tendon Disorders in Clinical Practice, DOI 10.1007/978-1-4471-4498-4_1, © Springer-Verlag London 2013