Achilles Tendon Repair

General remarks

Open operative treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared to non-operative treatment, but produces a higher risk of other complications

Percutaneous or minimally invasive surgery may reduce the risk of wound infection

Minimally invasive Achilles tendon repair in combination with a functional rehabilitation program is a safe and quick procedure with a low rate of rerupture and a high level of patient satisfaction

Post-operative splintage in a functional brace appears to reduce hospital stay, time off work and sports, and may lower overall complication rate

Step by step

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

References

Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized controlled trials. Khan RJ et al. J Bone Joint Surg Am. 2005 oct; 87 (10):2202-10 Postoperative rehabilitaion protocols for Achilles tendon ruptures: a meta-analysis. Suchak AA et al. Clin Orthop Relat Res. 2006;445:216-21 The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional aftertreatment. Lansdaal JR et al.Injury. 2007 Jul;38(7):839-44.