# Imaging of Foreign Body Reactions to Non-absorbable Sutures in Achilles Tendon Repair: Radiologic and Histopathologic Correlation in Two Cases

## TL;DR

This paper reports two cases where non-absorbable sutures used in Achilles tendon repair caused foreign body reactions, showing how imaging and surgery helped diagnose and treat the issue.

## Contribution

The paper highlights foreign body reactions as a rare but important complication of non-absorbable sutures in Achilles tendon repair.

## Key findings

- Foreign body reactions occurred months after surgery, presenting with swelling and erythema.
- Ultrasound and MRI showed cystic lesions and inflammation along the suture path.
- Surgical removal of sutures resolved symptoms and normalized imaging findings.

## Abstract

Achilles tendon ruptures are commonly managed with surgical repair, often using non-absorbable sutures for their tensile strength. However, foreign body reactions have been increasingly reported, accounting for up to 2% of complications in some studies, compared to approximately 3% for wound dehiscence.

We present two cases of biopsy-proven foreign body reactions following percutaneous Achilles tendon repair with FiberWire® (Arthrex, Naples, Florida) sutures. Both patients developed localized swelling and erythema months after surgery, without any systemic signs of infection. Ultrasound and MRI revealed cystic-like lesions along the suture path, accompanied by inflammatory changes. Surgical debridement and suture removal led to complete resolution of symptoms, with corresponding normalization on follow-up imaging.

Histopathology confirmed a foreign body reaction with giant cells and reactive fibroblast deposition. These cases emphasize the importance of recognizing foreign body reactions as a potential mimic of infection or rerupture, guiding appropriate management.