Surgery for a Torn Achilles Tendon

Achilles tendon ruptures are a common injury in the athletic population. Surgical repair of a ruptured Achilles tendon involves suturing the torn ends together using strong stitches. Traditionally a larger incision (~10cm) was required to fully expose the torn tendon ends and repair them.  Newer surgical equipment now allows for minimally invasive repair of Achilles tendon ruptures, using a much smaller incision (2-3cm).

Procedure

Surgery is done under a general or spinal anaesthetic in a prone position. Using the minimally invasive technique, a 2-3cm incision is made at the back of the calf at the tendon rupture site, and the tendon sheath (paratenon) is carefully opened. The ends of the torn tendon are then debrided and freed up.

A special jig is then inserted into the tendon sheath that allows precise guidance of the sutures through the skin and into the tendon. The jig is then removed, pulling the sutures out through the small skin incision. A further two 5mm incisions are made at the back of the heel, and the sutures from the upper part of the tendon repair are retrieved through these small cuts. The Achilles is tensioned appropriately so the torn ends are firmly opposed, and the sutures are then secured to the heel bone using two small strong anchors.

The tendon sheath and skin are then closed, and a local anaesthetic block is given to make the surgical area numb and provide pain relief for 6-12 hours. After surgery, the foot is placed into an articulated Achilles boot (VACOped).

This system provides a very strong way to repair the torn Achilles using small incisions and without the need for bulky suture knots at the rupture site.

Recovery

The surgery is usually performed as a day or overnight procedure. Patients are usually allowed to bear some weight in the boot after the operation. Dressings should remain dry and intact until review by your doctor two weeks after surgery.

Once the incision has completely healed, a graduated rehabilitation program is then commenced with progressive weight bearing, range of movement, and strengthening exercises. This is best done under the supervision of an experienced physiotherapist. The boot is generally on for up to 6 weeks, and patients can return to light jogging from about 4 months post-operatively, and return to sport from around 6 months.

Surgery does carry some risks, mainly the chance of wound infection or breakdown. The chance of re-rupture of the tendon in the future is slightly lower with operative repair. There is also less chance that the tendon will heal in an elongated position.