OrthoVirginia Blog

Minimally Invasive Achilles Repair

By: Paul J. Switaj, MD

The Achilles tendon is the largest and strongest tendon in the body. As the tendon moves toward the heel, the fibers rotate, giving it greater mechanical resistance, but creating an area with poor blood supply which may makes the Achilles prone to tearing in this area.

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Achilles tendon ruptures are quite common in the general population. Most happen with athletic activities that require sudden bursts of muscle power in the legs. Patients report the rupturing sensation as being similar to a kick to the heel or being hit with a ball or a bat in the heel. After a period of time the pain can sometimes resolve as the tendon does not assume any further strain. This makes some patients feel that they did not injure themselves. What is often noted, however, is a feeling of weakness with push off and difficulty with single heel raise. Prompt evaluation and diagnosis is critical.

Sometimes MRI or ultrasound will aid in confirming the tear, but in most instances physical examination of the patient will most often provide the diagnosis- this includes the Thompson's test.

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Appearance of left Achilles rupture. Notice of loss of contour of Achilles
Demonstration of Thompson's test (Courtesy John Campbell, MD)

Once the diagnosis is made, patients have 2 treatment choices: non-surgical treatment or surgery. There is evidence that non-operative treatment can provide good clinical outcomes overall and is associated with fewer wound healing problems; but it is associated with higher rates of re-rupture and prolonged recovery time.1-2

Surgery can decrease the rate of re-rupture, and is more likely to reestablish the correct length of the tendon, which is important in achieving near-normal push-off strength when finally healed. However, surgery has two potential complications as well: wound healing and scar adhesions (when the skin sticks to the tendon).

For those patients who choose surgery, minimally invasive Achilles tendon surgery can decrease both of these potential complications while achieving the goals of surgical treatment. The surgery is performed through an inch-long incision where the tendon ends are located. A specially-designed stitch device is then passed up and around the tendon, which guides sutures into the tendon and pulls them into the small incision. The sutures are then tied so the tendon ends meet, and when compared to the other leg, the foot and ankle should be in the same position. This means that the correct length of the tendon has been achieved.

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Left: Patient 10 days after surgery. Right: Different patient 6 weeks after surgery

The minimally invasive approach:

  • Avoids aggressive exposure of the tendon
  • Allows a very strong repair
  • Limits wound healing issues and scar tissue
  • Permits a more rapid return to full activity.3

It is not necessarily for every patient, as the condition of the tendon - or the ability to get a good hold on the tendon - needs to be assessed at the time of the repair. The surgery and rehabilitation can be adjusted depending on these factors. The minimally invasive technique has been used quite successfully in patients, and it is a very good consideration for repair of the Achilles tendon.

*Please note that Dr. Switaj has no financial relationship or conflict of interest in relation to this product

  1. Nilsson-Helander K, Silbernagel KG, Thomee R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatment using validated outcome measures. Am J Sports Med. 2010;38(11):2186-2193.
  2. Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg Am. 2010;92(14):2466-2468.
  3. Hsu, A et al. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures. Foot Ankle Int. 2015;36(11):1279-86
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