Minimally Invasive Achilles’ Tendon Repair

If you are suffering from an Achilles tendon rupture, there is a good chance that minimally invasive surgery may be an option for you. This surgical approach results in a smaller scar, less pain, and decreased chance of wound healing complications and infection. Let’s take a closer look at this type of surgery and find out if it is the right choice for you.

Achilles Tendon Ruptures

Achilles tendon ruptures are a common injury, especially in athletes. The Achilles tendon is the largest and strongest tendon in the body and connects the calf muscle to the heel bone. It is used when you walk, run or jump. A rupture can occur when this tendon is overstretched, such as during a forceful contraction of the calf muscles or when landing from a jump.

The most common symptom of an Achilles tendon rupture is sudden sharp pain in the back of the ankle. A common description is a sensation of being hit in the back of the leg by a large object like a baseball bat. This may be accompanied by swelling, bruising, and difficulty walking.

A complete rupture needs to be assessed by a foot and ankle specialist immediately to determine the most appropriate course of action. Depending on the circumstances, either a non-surgical/conservative appropriate or surgical repair may be recommended. Delays in diagnosis and lack of treatment can produce devastating outcomes if appropriate treatment is not implemented. For example, if a complete rupture occurs and either a surgical repair or formal non-operative treatment protocol is not put into place then the two ends can retract leading to significant weakness, disability, and chronic pain. Neglected ruptures are extremely challenging to treat and normally require a more complicated surgery to repair with longer rehabilitation, decreased ability to return to baseline athletics, and altered gait.

Diagnosis is normally clear cut through patient history and clinical examination but sometimes advanced imaging can help guide the most appropriate treatment. For example, in a patient that is older, less active and higher risk for surgery, a MRI can show how retracted the tendon ends are and if there isn’t significant retraction, a non-surgical approach could be considered.

Minimally Invasive Achilles Tendon Repair

Dr. Nodelman uses the PARS device for minimally invasive achilles tendon rupture repair. This stands for “percutaneous achilles repair system”. This device allows for sutures to be passed into both ends of the ruptured tendon through a small incision in the back of the calf.

This procedure is performed with general anesthesia in the operating room. The patient has the surgery performed while on their belly to allow for easier access to the back of the leg where the rupture occurred. A small incision is placed around the rupture at the PARS device is inserted to grasp the tendon. With the tendon secured with the PARS device, multiple sutures are passed.

The same is performed for the lower part of the rupture. Once all the sutures have been fed into the tendon, the tendon is brought back together and the sutures are tied tight.

The skin is then closed with stitches and a splint is applied to the leg.

Check this link out to see a cartoon demonstration of the procedure.

Achilles tendon rupture rehabilitation

Initially, non-weight bearing is implemented for approximately two weeks. At two weeks the sutures are removed. A large fracture walker is then put on the leg with multiple wedges placed under the heel. Physical therapy is typically commenced at this point too. As the week’s progress, the wedges from the heel are removed to bring the heel closer to the ground and increase the tension on the Achilles tendon as it heals. Normally patients can get back into a regular sneaker around 3 months after injury and slowly advance activities back to baseline over the proceeding months.

In conclusion, Achilles tendon injuries can be addressed surgically in some cases through a minimally invasive approach. The benefits of this include a smaller incision with fewer risks of wound healing issues and infection. There is less scar tissue and healing can typically be advanced sooner than an open procedure.