Oval Forceps–Assisted Minimally Invasive Suture Bridge Technique for Achilles Tendon Rupture developed

Dr Supreeth  D R

Oval Forceps–Assisted Minimally Invasive Suture Bridge Technique for Achilles Tendon Rupture developed

Written By : Dr Supreeth D R Published On 2025-12-30T21:00:53+05:30 | Updated On 30 Dec 2025 9:01 PM IST

The article – “A New Surgical Technique for Achilles Tendon Rupture: A Retrospective Study of 18 Cases” has been published in Indian journal of orthopedics.

“Many grassroots hospitals lack advanced equipment to perform effective minimally invasive surgeries, and open surgeries increase the incidence of complications. Therefore, we have developed a new technique specifically for grassroots hospitals. It involves using oval forceps-assisted minimally invasive suture bridge technology to treat acute closed Achilles tendon ruptures. This technique is easy to perform and has shown good clinical outcomes” - Dawei Xin, the first author of the article, opined.

The patient was positioned prone. A transverse incision of approximately 2.5 cm was made at the depressed area of the Achilles Tendon Rupture (ATR). The tissue layers were gradually dissected, and a sharp incision was made while protecting the peritendinous membrane of the tendon. The ends of the Achilles tendon were exposed and any hematoma was cleared. A periosteal detacher was used to fully free the proximal end of the tendon within the peritendinous membrane.

An oval forceps was then inserted into the peritendinous membrane to grasp the Achilles tendon. The position of the forceps was adjusted to hold the tendon between its two holes, applying appropriate tension while maintaining the position of the forceps. A lumbar puncture needle was inserted from the outside to the inside through the hole of the oval forceps and passed horizontally through the middle of the lateral side of the Achilles tendon. Three strands of 2-0 absorbable sutures (Ultrabraid, SMITH & NEPHEW, INC.) were pulled out, with each strand spaced approximately 0.5–1 cm apart, taking care to avoid injury to the sural nerve. The oval forceps was then removed, and at this point, the three sutures were pulled out from the peritendinous membrane along with the oval forceps through the incision.

Then, a 0.5 cm incision was made on both sides of the insertion point of the Achilles tendon. Blunt separation was performed with a vascular clamp down to the bone surface, and then a hole was drilled in the direction of the sole along the plantar aspect. Through this incision, a suture passer was used to pass the proximal suture subcutaneously within the Achilles tendon. After adjusting the tension of the suture to a satisfactory level, the sutures were fixed to the calcaneus using two external suture anchors (SMITH & NEPHEW, INC.).

After confirming appropriate tension of the Achilles tendon, the wound was irrigated with 0.9% saline solution. The peritendinous membrane and subcutaneous tissues were sutured with 2-0 absorbable sutures, and the skin was closed with 3-0 nylon sutures. A sterile dressing was applied and a short leg cast was applied with the ankle in a dorsiflexed position for immobilization.

The authors concluded – “The oval forceps-assisted suture bridge technique for treating acute closed ATR offers several advantages, including smaller incisions, meeting the early functional rehabilitation needs of patients, minimal complications, and the simplicity of the procedure. However, it is important to note that this study was a retrospective analysis with a small sample size and a short follow-up period, which may introduce certain biases into the results. In future studies, it is recommended to accumulate more cases, extend the follow-up period, and introduce a control group to further validate the findings of this study.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.