Achilles Tendon Repair

Indication

An Achilles tendon repair is often performed as treatment for a ruptured Achilles tendon

Procedure

Open Achilles Tendon repair

An Achilles tendon repair is most commonly performed through an open incision, either on the inside or on the back of the Achilles. The incision is dissected down to the ruptured Achilles tendon. Once the ruptured Achilles is reached, the torn ends are trimmed and cleaned up to prepare for attachment. The attachment is done by pointing the foot down and connecting the two torn tendon ends together with strong suture.  Once tendon ends have been secured the wound is carefully closed.

Mini-Open Incision

Another technique that is sometimes used to repair a ruptured Achilles is performed through a “mini-open” incision. In this procedure a small horizontal incision is made over the Achilles. A commercially available device is then used to facilitate the reconnection of the ruptured tendon with sutures in a blinded manner. The advantages of the mini-open technique include less soft tissue damage and less scaring. However, the disadvantages include a higher rate of local nerve injuries and the repair itself may not be as strong as the more common technique potentially leading to a higher re-rupture rate.

Recovery

Typical Standard Recovery

During the first 6-8 weeks, the foot is immobilized in a cast to allow the tendon and the surrounding tissues to heal properly. In addition, the tendon needs to be protected because the healing Achilles tendon may still be too weak to withstand the force of normal walking. After the 6-8 week mark, patients are place in a removable boot, often with a small heel lift to take some of the load off of the Achilles. At this point, patients can begin walking, but at a very slow rate. Physical therapy working on range of motion and low resistance strengthening is usually started at 6-8 weeks post surgery. Gradually over a series of weeks, the heel lift is removed, bringing the ankle back into its neutral position. In a traditional recovery the patient can transition into a regular shoe around 9-14 weeks post-surgery.

More Aggressive Achilles Rehabilitation

Younger more athletic patients who are very displined might benefit from a more Aggressive Athletic Rehabilitation.

Potential General Complications

The incision can be made in two different locations: on the back or on the side of the Achilles. Although the incision can be made on the back of the Achilles, an incision on the side will tend to avoid irritation from the scar when rubbed against the shoe during normal walking.

Potential Specific Complications

  • Wound healing
    Although this is usually a general complication for mostprocedures, the wound healing complication is particularly concerningfor an Achilles tendon repair! This is because the tendon itself has relatively little soft-tissue coverage and this area of skin has a notoriously poor blood supply. Therefore any type of wound healing problem can easily end up involving the tendon itself. For most patients there is approximately a 2-5% chance of a significant woundhealing problem.  However, the risk of a wound healing problem increases significantly in smokers and diabetics.
  • Infection
    A deep infection following an Achilles tendon repair can be a devastating problem. Often an infection will occur if there is an associated wound healing problem that allows bacteria from the outside world to contaminate the Achilles repair. Treatment may require not only antibiotics but potentially removal of all suture materials and in some instance the tendon itself. Smokers and Diabetics are at increased risk of a serious wound infection following Achilles Tendon repair surgery.
  • Re-rupture of the Achilles Tendon: The re-rupture rate is significantly lower in operatively (Achilles Tendon Repair) treated patients (2-5%) compared to patients treated non-operatively (8-15%). However, re-rupture is still a known complication.

Edited July 14th, 2009