Purpose: Percutaneous suture of the Achilles tendon is an excellent alternative to open surgery with the known risk of cutaneous and septic complications and also to orthopaedic surgery with the risk of recurrence. We propose our technique of percutaneous suture applied in a series of 76 patients.

Material and methods: Achilles tendon sutures were performed from 1998 to 2002 in 76 patients (17 women), mean age 41 years (22–66). The procedure was conducted under local anaesthesia in the outpatient setting. A resorbable knitted thread mounted on a needle was used to make the two-point frame percutaneous suture. The patients were immobilised for three weeks (average). The Thermann scores, modified by McComis, were determined and the objective Cybex test at 30 and 60/s was used to measure peak torque, power, and maximal power followed by 30 cycles at 120/s to evaluate muscle fatigability.

Results: Mean follow-up was 35 months (10–66). Outcome scores (maximum 100 points) showed excellent or good results in 73 patients and poor results in three. Mean operative time was 15 minutes with no immediate complications. Weight bearing was allowed as early as day 1 (range d1-d20) and patients resumed their occupational activities on day 40 (d8-d100). Sports activities were resumed at six months (4–8 months). Ankle motion was symmetrical and pain free in 73 patients. Calf circumference was 2 cm less than on the contralateral side (0.5-3.0). There were two cases of recurrent tears in patients with poor outcome. Decreased muscle force involving the triceps was never greater than 35% compared with the healthy side (Cybex).

Discussion: The objective Cybex measurements were tightly correlated with the McComis scores. This percutaneous technique does not require removal of the material and is perfectly reproducible in outpatients under local anaesthesia. It is an inexpensive method but remains contraindicated for tears seen late, recurrent tears, or very distal tears.

Conclusion: The very good results obtained in this series suggest we should continue with this low-cost percutaneous method.

Purpose: We propose a simple surgical treatment with sustained efficacy for chronic symptomatic acromioclavicular instability.

Material and methods: Dissection of ten cadaver specimens (20 shoulders) enabled a detailed biometry of the acromiocoracoid ligament (ACCL) with measures of motion and clavicular fixation. We were also able to measure tear resistance with a dynamometer. The proposed surgical technique was designed from Weaver-Dunn reconstruction as modified by Bircher. Briefly, acromioplasty is used to dis-insert the ACCL which is folded back on the clavicular resection border then fixed by screws or wires.

Results: The size of the acromioplasty section varied from 18 to 25 mm in diameter. The ACCL had a quadrilateral aspect: mean anterior length 37.7 mm, mean posterior length 25.6 mm, mean middle (coracoid) width 16 mm, mean lateral width 22.3 mm and mean thickness 1.55 mm. The fold angle was 68° on average giving 10.8 mm in height and 21.8 thickness. The coracoclavicular distance varied from 15.7 mm to 50.1 mm. Mean tear force was 11.5 daN.

Discussion: Posttraumatic osteoarthritis of the unstable acromioclavicular joint requires resection of the lateral quarter of the clavicle using the Baccarani technique which should be completed by a stabilisation fixation. The Weaver-Dunn technique appears to be insufficient for Rockwood stage IV and B chronic instability. The distance between the anterior border of the coracoid and the posterior border of the clavicle is within the reach of the length of the acromiocoracoid ligament. The available length allows tension adjustments before fixation, which should be performed preferably using a wire fixation or a 3.5 compression screw set on a washer to achieve satisfactory stability and good pull-out resistance.

Conclusion: Biometrics of the ACCL and the width of the acromioplasty and clavicular osteotomy demonstrate several possibilities for regulating the fixation which can thus be adapted to the morphology of each case while assuring good compression and solid fixation necessary for excellent long-term results.