FH Orthopedics

TENOLIG is the only system on the market that makes possible immediate mobilisation and quicker recovery and return to sport for the patient.

The Achilles tendon makes plantar flexion of the ankle possible (standing on tiptoe). The Achilles tendon is an intermediary for inserting the sural triceps muscle into the calcaneum, one of the heel bones. The sural triceps is a powerful calf muscle.

When the Achilles tendon tears, examination makes it possible to identify a hollow situated just above the heel and the calf sticks out because of the section of the sural triceps at its point of attachment.

The standard treatment proposed by surgeons facing the problem of a torn Achilles tendon varies between 2 solutions :

• pure orthopaedic treatment with immobilisation, or
• surgical repair (whether it is a simple suture or a complex repair operation). This is more often than not associated with strict immobilisation.
  

Histological and biological studies on tendon healing have made it possible to envisage surgical repair using a percutaneous approach, with the following objectives :

• a minimal, and not very aggressive, operation, which is quick and easy and within the capabilities of all surgeons,
• the shortest hospitalisation period possible,
• and above all, early and effective re-education, providing a satisfactory result both in terms of solidity and the comfort of the patient.
  

Follow-up of the results obtained over more than 15 years has allowed us to devise a technique that we now propose today.

The percutaneous tenosynthesis TENOLIG combines stability, reliability, patient comfort and lower overall social and professional costs for this type of lesion.

Indications

Surgical repair of a recently torn Achilles tendon, percutaneous approach.

Ideally, the operation should be performed within the first 8 days following the tear.

The tendon is relatively fragile and accidents (tears) are common, essentially in the course of physical activity (tennis, volley-ball, badminton…), particularly when the tendon is subjected to trauma caused by a movement that is too violent (e.g. when running a short but intense distance).

Tears are easy to recognise when they occur: there is the sound of tissues tearing (which can sometimes be heard from several metres away) and a very sharp pain below the calf.

The concept

Once torn, there are three main techniques to repair an Achilles tendon.
The choice between these various techniques can generally be made by the patient, unless the tear is particularly close to the bone, happened a long time ago, or falls under one of various particular cases depending on the diagnosis made by the surgeon.

>> PERCUTANEOUS TECHNIQUE

This technique consists in passing two threads mounted on a needle, into which are embedded small harpoons. The entry points are proximal, around 6 cm above the torn zone, on the posterolateral faces of the tendon. The exit points are on the posterolateral faces of the tendon, opposite the retromalleolar areas, 4 to 5 com below the tear.

The surgeon threads the two needles from top to bottom, percutaneously, through the torn tendon. The harpoons fix into the upper part of the tendon. The threads are then stretched downwards bringing the two parts of the tendon closer together, and blocked by means of polyethylene pellets in contact with the skin. The threads can be removed by the surgeon after around 6 weeks.

This technique has the advantage of having a low relapse rate and of being a minor operation, generally done in outpatient care. There is also a lower post-operative risk than with the standard technique. This technique should only be used in the first 8 days after the rupture.

The percutaneous technique is based on 4 principles :

1. Succeeding, with no surgical approach, in bringing together the two torn ends of the Achilles tendon, and keeping them together for 6 weeks whilst allowing mobilisation of the tendon block through flexion/extension movements of the foot.
2. Not devascularising the tendon by misplaced opening of its vascular sheath.
3. Preserving the perifracture haematoma as it is the guarantee of fast healing and good consolidation.
4. Allowing early mobilisation, which generates the alignment of the collagen fibres and their fast transformation into efficicent elastic tendinous fibres.

There are many advantages to this technique : it is a mini-invasive operation (percutaneous), less aggressive for the patient, can be performed in outpatient care, respects the tendon’s physiological healing process, and the technique is quick, easy, safe and reproducible.

The box contains the 2 complete TENOLIG kits required for normal percutaneous tenosynthesis.

Percutaneous tenosynthesis using TENOLIG is much more than a method for suturing a torn tendon. It is a real concept !

The factors for the success of TENOLIG are based on respecting the operating technique, but also strictly respecting the post-operative follow-up procedure.

>> ORTHOPAEDIC TECHNIQUE

This consists in putting a cast on the ankle up to beneath the knee, in two consecutive casts.

The first in the equine position (tip of the foot extended, so as to bring the two ends of the tendon together), and the second at 90°.

This non surgical technique nevertheless has the disadvantage of taking longer, requiring more physiotherapy and having the highest repeat tear rate (12 to 15 %).

>> STANDARD SURGICAL TECHNIQUE

This technique consists, after making an opening of 10 to 15 cm, in sewing together the two parts of the tendon. This technique is the one that has the lowest repeat tear rate, but is also subject to non negligible post-operative risk.

Products characteristics

The full kit is composed of :

• a thread 0.85 mm in diameter, 36 cm in usable length, on to which is mounted a harpoon with, embedded at its distal end, a triangular-tipped needle with a 1.5 mm diameter and a length of 15 cm, slightly curved when delivered, but modelable during
• surgery in a curve that is adapted to the type of tear treated;
• a perforated plomb for tightening;
• a polyethylene disc (UHMWPE), with a convex side providing only very slightly compressive pressure at the level of the skin, and a flat side.
• the box contains the 2 complete TENOLIG kits required for normal percutaneous tenosynthesis.