Revolutionizing Achilles Tendon Repair: A Comprehensive Proposal Integrating the WALANT Technique for Percutaneous Achilles Tenorrhaphy

Category: Sports Introduction/Purpose: Achilles tenorrhaphy is one of the most common procedures performed in foot and ankle surgery, and percutaneous techniques are safe and achieve good outcomes. Over the past 20 years, the WALANT technique (Wide-awake local anesthesia no-tourniquet) has gained popularity due to its advantages: it does not depend on the availability of complex operating rooms or anesthetists, allows for intraoperative functional evaluation, presents lower costs, and few complications have been reported. However, there is scarce literature regarding the complications associated with the WALANT technique in foot and ankle surgery, especially in percutaneous Achilles tenorrhaphy. Methods: A retrospective cohort study included patients over 18 who underwent percutaneous Achilles tenorrhaphy using the Dresden technique, with a minimum follow-up of 6 months. The WALANT group was treated on an outpatient basis in a minor surgery theater, while the standard treatment (ST) group underwent surgery in the main theater with spinal anesthesia. Categorical data were analyzed using the Chi-square test, with statistical significance set at p = 0.05. Results: A total of 51 patients were included (19 WALANT and 32 ST), all male, with an average age of 43.1 years. There was one case of surgical wound infection (SWI) in the WALANT group (5.26%); there were no cases of SWI in the ST group, with no statistically significant differences (p=0.18). In the WALANT group, there were no cases of re-rupture, and in the ST group, there was 1 (6.3%) re-rupture that did not require reintervention; no statistically significant difference was found (p=0.19). Additionally, 15.79% of the WALANT group presented with transient hypoesthesia (up to 6 months) of the sural nerve, compared to 3.13% in the ST group, with no statistically significant differences (p=0.10). No cases of deep venous thrombosis were found in either group. Conclusion: The WALANT technique demonstrates no differences in complications between the two groups, indicating it is considered a safe technique regarding associated complications. It's worth mentioning that the WALANT technique is considered a more cost-effective option due to the lower use of resources.