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Fig. 4 | Journal of Orthopaedic Surgery and Research

Fig. 4

From: Channel-assisted minimally invasive repair of acute Achilles tendon rupture

Fig. 4

Achilles tendon repair with the help of the CAMIR device. a Stab incisions (5 mm) were made through the targeting hole in the limbs. b Two trocars with a channel sleeve were introduced through the limb hole, stab incision, and sheath to touch the tendon. There was a two-sided 1.5-cm long blade and blunt tip at the end of the trocar. c The paratenon sheath could be cut open longitudinally for about 1 cm with the blade by pushing the system proximally or pulling it distally. The sleeve was then placed through the skin and sheath into the hole in the internal limb. d After removing the trocar, the suture channel could move proximally or distally along with the surface of the Achilles tendon, allowing Bunnell suturing. e Holding the stump and pushing the device proximally, a No. 2 Ethibond suture was passed through the channel and the tendon with the needle and neutral guide. It exited from the opposite channel. Pulling the device distally, the suture passed through the opposite channel and tendon with the needle and eccentric guide and exited from the channel. The other end of the suture passed through the channel and tendon with the needle and neutral guide and exited from the opposite channel. f The channel sleeve was removed, and the device was slowly withdrawn and progressively closed. Thus, the suture exited the incision, trapping the proximal tendon stump in a Bunnell fashion inside the paratenon sheath. g After placing sutures in the proximal part of the rupture, we tested the strength of the sutures in the tendon by pulling on the sutures with force. h A similar maneuver was performed in the distal stump, with the suture passed through the calcaneus bone tunnel. i The two sutures were knotted with the foot in equinus position augmented with intermittent absorbable Vicryl 3-0 sutures

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