Achilles Tendon Repair Surgery

Partial Achilles tendon tears and tendon tears in patients with minimal displacement can be treated conservatively with walking boot and wedges. The number of wedges will have to be gradually reduced over a period of 6 to 12 weeks to get the foot plantigrade. However, the push off strength of the achilles tendon and calf muscle may not return to the pre-injury level. 

 

In people with acute tear of the muscle and in those with a large gap between the two ends of the torn achilles tendon, surgical treatment is appropriate. Surgical treatment may be percutaneous through small cuts in some. The technique permits mobilisation of the tendon and fixation in some, however there is a higher risk of nerve injuries in these. 

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Diagnosis

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With good physical examination, the Achilles tendon tear can be identified easily due to the gap in the tendon. However, in partial tears and in tears higher up at the musculo-tendinous junction may be difficult to appreciate  with the clinical examination.

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X-ray. X-ray is often performed and is useful to rule out any bone injuries. However, Achilles tendon tear is not easy to appreciate on the X-ray.

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USG Scan. Ultrasound scan is often sufficient to understand the nature of Achilles tear and the gap. 

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MRI Scan. MRI Scan helps in undertanding the nature of the tear, gap and the quality of the remaining stump of the tendon along with the condition of the surrounding tissues.

 

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Treatment

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First Aid for Achilles injuries involves the typical R.I.C.E therapy initially (Rest, Icepacks, Compression and Elevation).

 

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Partial Achilles Tear / Degenerative Achilles Tear (Acute)

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Partial Achilles tears and degenerative tears can be treated conservatively provided the patient is seeking medical attention in the initial few weeks post injury. A walking boot with wedges for 6 to 12 weeks is necessary. The results can be satisfactory provided the patient is not into active sports or high intensity activities. 

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Achilles Tendon Surgery

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• Achilles tendon surgery is a day care surgery. There are various ways of repairing the torn tendon.

• Percutaneous repair may suit some. 

• End to End repair by using strong Fiberwires and Krakow technique in mid substance tear of the achilles. 

• Speed-bridge technique is used when the Achilles tendon is avulsed from the calcaneus or when the distal stump of the tendon is not degenerative and not repairable. In this technique, we use bio suture anchors to fix the tendon to the bone. The bone bed of calcaneous is usually prepared by removing the osteophytes, making tiny holes in the calcaneus with K wires or even shaving a bit of bone to expose the cancellous bone so that the tendon can form strong connect with and grow into the bone. 

• FHL Tendon transfer. In patients with poor degenerative distal stump of tendon and long gap to bridge, an FHL tendon transfer to the calcaeous and fixation by using bio-screw is undertaken. The remaining proximal stump of the Achilles tendon is attached to the the FHL so that these muscles will then work as one unit. 

• Allograft Repair: In patients with no useful distal stump of tendon, Allograft is an excellent choice to bridge the gap. The repair to the done distally is done by Speedbridge technique and proximally by Krakow technique. 

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Achilles Repair Surgery Rehabilitation

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Post-surgery you can expect to be in a walking boot with wedges initially. Early mobilisation is recommended. Depending on the type of repair you may need to use the walking boot for 4 to 8 weeks. Full mobility is expected by 6 to 8 weeks. To get back to running and other high impact activities usually around 6 to 8 months of time period is necessary. 

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