Achilles Tendon Repair Surgery Steps
How long you can walk after Achilles tendon surgery?
How is Achilles tendon surgery performed?
Weight bearing after Achilles tendon repair
Are you awake during Achilles tendon surgery?
How successful is Achilles tendon surgery?
Rupture of the Achilles tendon often leads to long-term morbidity, particularly calf weakness associated with tendon elongation. Operative repair of Achilles tendon ruptures leads to reduced tendon elongation. Tendon lengthening is a key problem in the restoration of function following Achilles tendon rupture. A study was performed to determine differences in initial separation, strength and failure characteristics of differing sutures and numbers of core strands in a percutaneous Achilles tendon repair model in response to initial loading.
Nineteen bovine Achilles tendons were repaired using a percutaneous/minimally invasive technique with a combination of a modified Bunnell suture proximally and a Kessler suture distally, using non-absorbable 4-strand 6-strand repairs and absorbable 8-strand sutures. Specimens were then cyclically loaded using phases of 10 cycles of 100 N, 100 cycles of 100 N, 100 cycles of 190 N consistent with early range of motion training and weight-bearing, before being loaded to failure.
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Read more about: Achilles Tendon Repair Surgery
Percutaneous Achilles tendon repair
Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon.
Reconstruction with VY advancement
A double V-Y advancement flap based upon a vertical subcutaneous pedicle was assessed for reconstruction of moderate sized defects of the anterior lower leg. The technique is described and the results of a retrospective analysis of thirteen cases are given. The procedure has proven to be a reliable alternative means of providing skin cover in this area.
flexor hallucis longus transfer +/- VY advancement of gastrocnemius
The Achilles tendon is one of the most commonly ruptured tendons of the lower extremity. Clinically, acute Achilles tendon rupture can be easily diagnosed and cured; however, a significant number of cases are still neglected without treatments. Chronic Achilles tendon rupture is usually defined as the rupture that occurs in 4 to 6 weeks after injury. The symptoms of chronic Achilles tendon rupture include pain, decreased strength, fatigue, and ankle stiffness. During physical examination, a palpable gap between the rupture ends can be observed. Chronic Achilles tendon rupture often occurs 2 to 6 cm proximal to the stumps, but it sometimes can also be observed at the stumps. Usually, small gaps (less than or equal to 2 mm) of chronic Achilles tendon rupture can be directly closed in an end-to-end manner. However, there is still no standard treatment for chronic Achilles tendon rupture with large gaps. Recently, Den Hartog used a flexor halluces longus tendon (FHLT) transfer for all defects over 2 cm. But Park and Sung deemed that gaps greater than 4 cm in chronic Achilles tendon rupture that underwent various reconstruction methods depending on the state of the remaining could achieve good outcomes.
Read more about: Achilles Tendon Repair Surgery Techniques
How long you can walk after Achilles tendon surgery?
You will need to wear a cast or walking boot for 6 to 12 weeks after surgery. At first, it may be set to keep your foot pointed downward as the tendon heals. You may be able to put weight on your affected leg after a few weeks. But it will be several months before you have complete use of your leg and ankle.
Read more about: Achilles Tendon Repair Surgery Time
How is Achilles tendon surgery performed?
Achilles tendon surgery can be done with several methods. The surgery is done by an orthopedic surgeon and a team of specialized healthcare providers. Ask your healthcare provider about the details of your surgery. The surgery may take a couple of hours. During your surgery:
- You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation. This will help you sleep through the surgery.
- A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
- The surgeon will make an incision through the skin and muscle of your calf. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she may then use a tiny camera with a light to help do the surgery.
- Your surgeon will make an incision through the sheath that surrounds the tendon. He or she will remove parts of your damaged tendon, or repair the rip in the tendon.
- Your surgeon may remove another tendon from your foot. This is then used to replace part or all of the Achilles tendon.
- Your surgeon will make any other repairs that are needed.
- The healthcare provider will close the layers of skin and muscle around your calf with sutures.
Read more about: Achilles Tendon Repair Surgery Recovery
Weight bearing after Achilles tendon repair
Without proper healing of an Achilles tear, a person’s ability to walk, jog, jump, and perform other high impact activity will be limited. A tear can be treated either with casting or with surgical repair. Cast treatment requires 6-8 weeks of non-weight bearing cast immobilization, followed by several weeks in a walking boot, to make sure the tendon is completely healed in proper position. (Total time until boot removal is 3-4 months).
Surgical repair of an Achilles can usually be performed through a small (3/4”) incision, and requires just 3-4 weeks non-weight bearing and an additional 2-3 weeks in a walking boot. (Total time until boot removal is 5-6 weeks). Surgery results in a much quicker recovery and return to regular activities than non-operative treatment, and a slightly lower rate of re-rupturing the tendon. However, most studies show that at 1 year following the injury, functional results of cast treatment and surgical repair are about equal.
Read more about: Achilles Tendon Repair Surgery Complications
Are you awake during Achilles tendon surgery?
You will be given general anesthesia to keep you asleep and free from pain during surgery. You may also be given local anesthesia to numb the surgery area.
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How successful is Achilles tendon surgery?
Both open and percutaneous surgeries are successful. More than 80 out of 100 people who have surgery for an Achilles tendon rupture are able to return to all the activities they did before the injury, including returning to sports.
It is sometimes difficult to know how surgeries compare, because the ages and activities of those having the surgeries differ. The success of your surgery can depend on your surgeon's experience, the type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is done, and how soon your rehabilitation program starts after surgery and how well you follow it.
Talk to your surgeon about his or her surgical experience and success rate with the technique that would best treat your condition.
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