A CLINICAL TEST TO AVOID SURAL NERVE INJURIES IN PERCUTANEOUS ACHILLES TENDON REPAIRS

Abstract

Introduction: Percutaneous repairs of Achilles tendon ruptures has gained popularity due the reduced incidence of wound complications, however its use is still limited by the high incidence of sural nerve injuries associated with these repairs. The only technique described to avoid this adverse event is to surgically expose the nerve peri – operatively.

Materials & Methods: In our study we describe and validate a clinical technique to identify the sural nerve. The technique describes flexing the knee to 90°, and supinating the forefoot and inverted the hindfoot. The sural nerve is at its greatest tension in this position and thus the nerve can be palpated along its path. The sural nerve was mapped using this technique both clinically and by US in a cohort of male subjects with intact Achilles tendons.

Results: We demonstrated an excellent correlation between the clinical and US mapping. It also showed excellent inter – observer and intra – observer mapping rates.

Discussion: Sural nerve injuries occur in up to 18% of percutaneous repairs due to the close proximity of the nerve to the tendon along its lateral border. The resultant pain or parasthesia experienced by the patient from sural nerve injuries results in a profound morbidity. This morbidity has lead to the reduced popularity of this procedure. The clinical mapping is a simple easy test, which identifies the nerve along its path and thus the nerve can be avoided during the procedure.

Conclusion: This study demonstrates an accurate and repeatable clinical technique for mapping the sural nerve in conjunction with percutaneous Achilles tendon repairs.