Open surgical repair of the tendon allows direct visualization and the ability to restore functional length of the musculotendinous unit. The longitudinal skin incision is placed medially to avoid the sural nerve (Fig. 69-6). The tissues are elevated with a full thickness flap until the paratenon is reached. The paratenon is incised and the tendon ends are identified. A minimal to no touch technique for the tendon is used, with a no. 5 nonab-sorbable suture with application of simple modified Kessler, Bunnell, or Krackow interlocking stitch. Also an absorbable 2-0 interrupted or running epitendinous suture can be placed. A four-strand repair is advocated to increase strength and allow aggressive rehabilitation. Bulky knots or suture should not be placed directly beneath the incision. The paratenon should be closed over the repair to prevent skin adherence to the tendon. The appropriate tensioning of the repair is crucial, and draping out the contralateral uninjured extremity to allow comparison of ankle dorsiflexion is recommended. The appropriate tension is set with the knee in 90 degrees of flexion. Postoperatively, the patient is placed in a cast or splint with the foot at 30 degrees of equinus to minimize tension on the soft tissues and repair.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.