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Minimally invasive achilles tendon repair, Step by step
- Place patient in prone position
- Make a 3cm transverse incision approximately 3-5cm cranial to palpable gap (that marks tendon defect)
- Dissect the subcutaneous tissue
- Identify and preserve small saphenous vein and sural nerve (lateral)
- Vertically opening peritendineum
- Place Bunnell's suture through proximal stump (use an a-traumatic polydioxanone S no. 0)
- Make stab incision lateral at the tuber calcaneii and bluntly prepare route towards calcaneus
- Drill a 2.0mm hole through the calcaneus, lateral to medial and perpendicular to tendon's direction
- Bring out drill medial through second stab incision
- Introduce suture retriever in lateral stab incision and bring to towards transverse incision (inside tendon sheath)
- Pull PDS through from proximal incision, push it through the calcaneus and then upwards under the tendon sheath back into the proximal incision
- Tie the suture with ankle in plantar flexion
- Close the peritendineum with absorbable suture
- Wound closure
- Apply below-knee plaster with the ankle in 20 degrees plantar flexion
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