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Background: Typical complications of the surgical treatment of acute Achilles tendon rupture are wound infection, seroma, skin tethering, sural nerve damage and hypertrophic scar. Some percutaneous or mini-open methods for acute Achilles tendon repair have been developed recently. Many of them have specific complications such as sural nerve damage, scar adhesion at the rupture site or maladaptation of the tendon.

Method: To minimize these complications, we describe a technique using 2 transverse incisions, leaving the rupture site under a bridge of intact peritendineum. The sural nerve is exposed and spared from damage using the cranial incision. The aim of this surgical technique is to minimize complications concerning wound healing, scar adhesions at the rupture site, maladaptation of the tendon ends, damage to the sural nerve and seroma due to large-diameter resorbable sutures.

Results: Between 2008 and 2010, we treated 47 patients with a mean age of 50 years who sustained a complete rupture of the Achilles tendon. Forty-one patients were re-evaluated after an average of 7 months. Thirty-seven Achilles tendons healed without complications. Complications were one delayed wound healing, two re-ruptures after trauma and one deep vein thrombosis.

Conclusion: Combined with a good clinical outcome, this minimally invasive technique may reduce the incidence of sural nerve entrapment. An early functional rehabilitation program is possible with full weight-bearing using a brace.