There are three main types of Achilles tendon surgery: percutaneous repair, open repair, and mini-open repair. The surgery a person has depends on the type of injury and the condition of the Achilles tendon.
The Achilles tendon is the strongest and largest tendon in the body. However, despite its strength, it is also the most ruptured tendon. Moreover, rupture rates are also increasing in line with an aging population, obesity, and the rise in sports participation.
Treatment of Achilles rupture typically involves conservative rehabilitation techniques and repair surgery, both of which have costs and benefits. Research generally suggests that Achilles tendon repair surgery has more favorable outcomes but may carry a risk of infection and a longer recovery period.
As the name suggests, Achilles tendon repair surgery aims to heal the Achilles tendon and help prevent issues that may hinder walking or sporting activities.
Three surgical techniques can repair the Achilles tendon.
Percutaneous repair
A percutaneous repair is
Mini-open repair
This mini-open repair aims to minimize complications such as infection and nerve damage. After locating the rupture site, the surgeon makes a small incision, which allows them to repair the tissue with sutures using a medical device.
Open repair
Unlike the percutaneous and mini-open repair approaches, open repair carries a higher infection risk and may also leave visible scarring. However, the risk of complications is roughly the same for all three techniques.
Depending on the injury or condition of the Achilles tendon, a surgeon may perform one of the following:
- Tendon graft: The surgeon uses a tissue graft to reconstruct some of the tendon. The graft can be natural, meaning it originates from a person or a donor, or artificial.
- Tendon transfer: The surgeon moves a healthy foot tendon into a different position to stabilize the Achilles tendon.
- Achilles debridement: When a surgeon cannot repair the tissue, they remove it. This specifically refers to the removal of damaged tissue and deposits from the tendon.
- Gastrocnemius recession: The surgeon makes an incision to partly release some of the calf muscle, reducing tension in the Achilles tendon.
A person may need Achilles surgery after rupturing their Achilles tendon. People between
A partial tear occurs when the Achilles tendon stretches, causing some of the fibers to fray but not completely snap. In contrast, a complete tear happens when the tendon undergoes a significant amount of stress, causing it to snap completely.
The types of injuries that can result in a complete tear may include:
- landing awkwardly with impact after jumping, tripping, or falling
- a person stepping on the heel bone of another when running at speed
When a person has a weakened Achilles tendon, over time, they may need surgery. Chronic diseases can weaken the Achilles tendon and can include:
- inflammatory diseases, such as rheumatoid arthritis and lupus
- obesity
- infection
- diabetes mellitus
- metabolic disease
Before surgery, a person will receive either a local or general anesthetic. A local anesthetic numbs the region where the surgery takes place, while a general anesthetic puts a person to sleep.
The location and extent of the injury determine the surgical technique a surgeon uses. All approaches involve some form of incision that allows the surgeon to access the tendon. After identifying and cleaning the tendon, they will stitch it back together. They may also use a graft or foot tendon to reconstruct or strengthen the Achilles tendon if stitches alone cannot fully repair it.
Surgery should take place soon after the injury to avoid scarring and shortening of the tendon.
Because the procedure involves an anesthetic, the surgeon will advise on when to stop eating and drinking before surgery. Before a person undergoes surgery, their doctor assesses the tear with imaging tests that may include:
These imaging tests help the doctor determine the severity and location of the tear and help rule out other conditions.
Like any other invasive procedure, Achilles surgery can carry a risk of complications. These may include:
- infection
- retearing of Achilles tendon
- pain
- weakness in movement when using the tendon
- wound breakdown
- nerve injury
- blood clots
- anesthesia complications
After Achilles surgery, a person can expect the following aftercare:
- medication to manage pain
- advice to keep the leg elevated
- around 6 weeks of wearing a brace, boot, plaster splint, or cast to immobilize the tendon as it heals
As time goes on, the doctor will remove the boot and suggest the person move their leg to regain some range of motion. The individual also needs to perform strengthening exercises as part of a rehabilitation program.
Generally, it takes 12 months to recover completely from the surgery, but it can take up to 2 years.
Achilles tendon repair surgery is a procedure to heal the Achilles tendon, typically after an injury such as a rupture. Some techniques are less invasive than others, and the type a surgeon chooses depends on the location and severity of the injury. However, they all involve small incisions to the ankle to access the tendon and stitch it back together.
A person should receive surgery as soon as possible after the injury. The longer the tendon does not receive treatment, the higher the risk of shortening and scarring. A complete recovery from surgery is typically 12 months, though it can take up to 2 years for some people.