Case Study: Achilles Tendon Repair
using PARS in a 35 year-old man
PARS (Percutaneous Achilles Repair System) is a ground-breaking minimally invasive method for Achilles Tendon Rupture Repair. Because recovery from the minimally invasive PARS surgery is substantially faster than with a typical open repair procedure, the PARS Procedure heals faster.
The patient, a 35-year-old man, came to see a doctor at the clinic after experiencing pain in the back of his left heel while playing basketball. Afterward, he started to limp. At the hospital, he was observed.
He was given a splint there and was thought to have an Achilles tendon tear. When We performed the MRI and saw him again in my clinic, the diagnosis was confirmed.
We talked about both surgical and nonsurgical therapy options. He decided on surgical treatment. We talked about the dangers and complications, including infection, bleeding, harm to the nerves and blood vessels, wound dehiscence, and re-rupture.
We also talked about recovery, the need for time to get back to his pre-injury state, and the chance that he might not be as fully athletic following the operation. The patient signed the informed consent after fully understanding it.
In the operating room, general anesthesia was produced on the patient. The block was local. On a bed that was well-padded, had cushions, and a bolster, the patient was lying face down. Pillows were used to support the left leg. Inflating the left tourniquet.
The left leg was prepared as normal and draped. A break was announced. The tourniquet was raised. Ancef 2 g was administered as a preoperative antibiotic to the heel area. A medial to midline incision was made along the Achilles tendon.
Sharp dissection was used to access the paratenon, which was thinned out and damaged. It was cut open with a knife. The underlying tendo Achilles was entirely ruptured, with frayed edges. Metz was used to dissect it inside the paratenon. The distal end of the proximal tendo
Achilles was ragged and difficult to grasp with Achilles. It was held with difficulty, and the PARS jig was placed proximally inside the paratenon. The tendo Achilles may be felt between the PARS jig’s two prongs. Once in place, needles were inserted into the #1 hole and left to stabilize.
The second needle was inserted into the #2 holes, and 1.3 mm blue-white Fiber Tape was threaded through the tendon. This was followed by inserting the needle through the #3 and #4 holes, the loop through the #4 hole, and the Fiber Loop trail through the #3 holes.
This was followed by inserting the needle into the #5 holes and inserting a 1.3 mm Fiber Tape. Finally, white 1.3 mm Fiber Tape was threaded into the #1 hole. Once all three Fiber Tape and two Fiber Loops were in place, the PARS jig and all sutures were extracted through the incision. Sutures were closed individually to ensure that they were securely supporting the tendon, which was stable.
The blue-white FiberTape was then wrapped around the third and fourth FiberLoops and passed to the loop on each side, while the FiberLoops were pulled from their tails to secure the second Fiber Tape around the tendon. This was accomplished.
Only the three FiberTapes remained over the tendon. A distal incision was made on either side of the Achilles tendon, immediately proximal to the calcaneal tuberosity. The bone was reachable. With a drill and a 45:45 inclination oriented inferiorly and towards the midline on either side, bone was bored for the insertion of a 4.75 SwiveLock.
A banana lasso with a loop was utilized to recover the FiberTapes from either side. They were extracted and passed through the SwiveLock 4.75 mm, which was then put into the calcaneal tuberosity after the sutures were tightened on either side one after the other.
Good fixation was achieved and a good tension with the foot in plantar flexion. Once the fixation was achieved, the Thompson sign was positive and the tendo Achilles could be seen moving with the attempted dorsiflexion of the foot.
The wound was thoroughly irrigated and drained. Paratenon was closed with the use of 2-0 Vicryl followed by skin closure using 2-0 Vicryl and 3-0 Monocryl. The stab incisions for the Swivelock were also closed with the use of the Monocryl. Dermabond was applied to seal the skin.
Telfa dressing was done with the use of Telfa, 4×4, ABD, and Webril. A posterior splint was applied in plantar flexion and a knee strap was applied. The patient was turned supine into the bed, extubated and moved to recovery in stable condition. Tourniquet was released in 67 minutes.
One week after the surgery, the patient was seen in the office for his postoperative examination. The patient has no fever or chill, the pain is well controlled however, she is still using crutches and ambulating NWB. We discussed treatment options including PT, MRI, Injection, surgery. NWB with posterior splint.
After one month the patient visits the office, the pain is well controlled. Though, he is still using crutches and ambulating WBAT with boots and wedges which are being weaned off.
He is working now with his PT. The patient’s progress and development have been undeniable with continued physical treatment and regular attendance at his follow-up checkups.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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