Surgical methods for treating Achilles tendon ruptures include open and minimally invasive surgery (MIS). MIS offers notable advantages, including reduced rates of infection and wound necrosis
however, it also introduces the risk of sural nerve injury. Intraoperative ultrasonography can mitigate this risk by providing real-time visualization of the sural nerve and Achilles tendon, improving clinical outcomes. This article introduces a novel ultrasound-guided suturing technique for Achilles tendon repair using a percutaneous Achilles repair system (PARS). This technique does not require the use of a jig, which is conventionally used in the standard PARS procedure to ensure accurate and controlled percutaneous suture placement in the Achilles tendon, making it less invasive than conventional methods. Additionally, it allows for more precise intraoperative visualization of the sural nerve using ultrasonography, enabling safer Achilles tendon repair.