Minimally Invasive Achilles Repair

Minimally invasive Achilles repair is a surgical technique to treat a tear or rupture of the Achilles tendon using a small incision. A traditional open surgery for repair of an Achilles tendon tear would involve making a larger incision - about 10 cm, or 4 inches - in order to fully expose the torn tendon ends and repair them. Conversely, minimally invasive Achilles repair involves making a smaller incision - about 2 to 3 cm long, or 1 inch - at the rupture site in the back of the calf and using a special device to capture and sew the torn ends of the Achilles tendon together.

Disease Overview

The Achilles tendon is a strong, fibrous cord behind the ankle that connects the calf muscle to the heel bone. It is used when you walk, run, or jump. An Achilles tendon rupture occurs most often in middle-aged athletes participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause an Achilles tendon rupture include tennis, racquetball, basketball, and badminton. If your Achilles tendon is ruptured, you will experience severe pain in the back of your leg, swelling, stiffness, and difficulty standing on tiptoes and pushing the leg when walking. A popping or snapping sound is usually heard when the injury occurs. You may also feel a gap or depression in the tendon, just above your heel bone.

Indications

Your surgeon may recommend a minimally invasive Achilles repair to treat an Achilles tendon injury in the following scenarios:

• When the damage is severe
• For both partial and complete tears
• When non-surgical treatment, such as physical therapy has been ineffective
• You are an active individual or athlete who wants to return to sports at the earliest opportunity
• Your job requires strenuous physical activity and you wish to return to work soon
• For individuals with Achilles tendinitis that has not healed with a comprehensive physical therapy program

Preparation

Preparation for minimally invasive Achilles repair may involve the following steps:

• A review of your medical history and routine lab work such as blood testing
• Informing your doctor of current medications or supplements you are taking, or any allergies to medications, anesthesia, or latex
• Disclosing any recent illnesses or other medical conditions you have, such as heart or lung disease
• Refraining from certain medications such as blood thinners, which may affect clotting
• Refraining from solids or liquids at least 8 hours prior to surgery
• Abstaining from smoking at least 2 weeks prior to surgery, and several weeks after, to promote heart and lung function and to improve tendon healing
• Arranging for someone to drive you home after the procedure
• Signing an informed consent form

Surgical procedure

In general, minimally invasive Achilles repair will involve the following steps:

• You will be placed on the operating table in a face-down position to enable access to the back of the leg where the rupture has occurred.
• You will typically be administered a general or spinal anesthetic.
• The surgical site is cleaned with an antiseptic solution, and using a minimally invasive technique, an inch-long incision is made where the tendon ends are located.
• The tendon sheath (paratenon) is carefully opened, and your surgeon debrides and frees up the ends of the torn tendon.
• A specially designed stitch device is then passed up and around the tendon, which guides sutures (stitches) into the tendon and pulls them into the small incision.
• The sutures are then tied so the tendon ends meet. 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 accomplished.
• The wound is then closed with sutures, and the ankle is immobilized in a cast or splint to facilitate healing.

Postoperative care

In general, postoperative care and recovery after minimally invasive Achilles repair will involve the following steps:

• You will likely experience pain and swelling in the surgical area. Medications will be provided as needed to address these.
• You may also apply ice bags over a towel to the surgical site for about 15-20 minutes to reduce postoperative pain and swelling.
• You are advised to keep your foot elevated at or above the level of your heart for a couple of weeks to help minimize swelling and discomfort.
• You will be provided with crutches to ambulate safely as soon as you feel comfortable.
• The sutures and cast/splint are removed after two weeks, and you will be transitioned into a CAM boot with heel raises/wedges.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• You should refrain from strenuous exercises or activities for a defined period.
• A physical therapy regimen will be started a week or two after surgery to strengthen ankle muscles and optimize foot function.

Benefits

Some of the benefits of minimally invasive Achilles repair over traditional open surgery include:

• Minimal muscle trauma
• Minimal scarring
• Allows a solid repair
• Prevents excessive exposure of the tendon
• Less pain
• Quicker healing of the tendon
• Minimized risk of infection
• Accelerated rehabilitation program
• Shorter hospital stay
• Quicker recovery
• Allows a return to full activity sooner

Risks and Complications

Minimally invasive Achilles repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following: 

• Infection
• Bleeding
• Persistent pain
• Calf weakness
• Nerve damage
• Wound healing problems
• Thromboembolism or blood clots
• Adverse reaction to anesthesia

Summary

Minimally invasive Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon using small incisions. This technique is usually considered to be the ideal approach to treating Achilles tendon tears, as it enables a faster return to normal activities, a shorter recovery period, and minimal pain compared to an open repair.