Review Question - QID 214033

The sural nerve must be protected during achilles tendon surgery and is depicted by D in Figure A.

To prevent heel and lateral foot numbness, the sural nerve should be protected during achilles tendon surgery. While open repair of a ruptured Achilles tendon is associated with a higher complication rate than percutaneous repair, no significant differences in the rates of sural nerve injury in the two techniques have been reported in the literature. The sural nerve is accompanied by the small saphenous vein, which runs just parallel and lateral to the nerve.

Grassi et al. investigated the complications, outcomes, and functional results between minimally invasive surgery (MIS) and open repair of an achilles tendon rupture. They reported a significant decreased risk ratio for overall complications after minimally invasive surgery compared to open, the MIS group was more likely to report good or excellent subjective results, and no difference in rerupture rates or sural nerve injuries in the two groups. They concluded that the current literature exhibits high heterogeneity and a considerable risk of bias.

Figure A depicts an a T1 axial MRI at the level of the ankle. Arrows A represents the peroneus longus tendon, B represents the peroneus brevis tendon, C represents the small saphenous vein, D represents the sural nerve, and E represents the flexor hallucis longus tendon.

Incorrect Answers:
Answer 1: This represents the peroneus longus tendon.
Answer 2: This represents the peroneus brevis tendon, just posterior to the fibula.
Answer 3: This represents the small saphenous vein, which often lies just lateral to the sural nerve.
Answer 5: This represents the flexor hallucis longus tendon.