Achilles Tendon Repair

Indication:

An Achilles tendon repair is often performed as treatment for an acute rupture of the tendon.

Procedure:

Performed under General anaesthetic with nerve block as day case surgery

Open Achilles Tendon repair

An Achilles tendon repair is most commonly performed through an open incision, located over the site of tendon rupture at the back of the leg. 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 suture them for reattachment. The ankle is positioned with toes pointing down so that the repair can be performed and the area of the repair is not under tension. Once tendon ends have been secured the wound is carefully closed.

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 2 weeks, patients are placed in a removable boot, often with a heel lift (wedges) to take some of the load off of the Achilles. At this point, patients can begin walking, but at a slow pace initially.  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 10 weeks post-surgery.

Potential Complications

• Wound Healing: the wound healing complication is particularly concerning for an Achilles tendon repair. This is because the tendon itself has relatively little soft-tissue coverage and this area of skin has a 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 wound-healing 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 to contaminate the Achilles repair. Treatment may require not only antibiotics, but also potentially the removal of all suture materials and, in some instances, removal of the tendon itself. Smokers and diabetics are at an increased risk of a serious wound infection following Achilles tendon repair surgery.
• Re-rupture of the Achilles tendon: The re-rupture rate is lower in operatively (Achilles Tendon Repair) treated patients (2-5%) compared to patients treated non-operatively (5-10%). However, re-rupture is still a known complication.
• Scar Irritation: 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.
• Deep venous Thrombosis: a daily subcutaneous injection of blood thinner (Low Molecular Weight Heparin) will be prescribed for 6 weeks after surgery.
• Pulmonary Embolism (PE) rare