ACHILLES TENDON REPAIR
WHAT IS AN ACHILLES TENDON RUPTURE?
An Achilles tendon rupture is an injury that occurs when the Achilles tendon, which connects the calf muscle to the heel bone, partially or completely tears. This tendon is crucial for flexion of the foot, especially during walking, running, and other movements involving the lower leg.
Achilles tendon ruptures usually occur during a sporting activity that involves sudden movements of the leg, such as jumping or sprinting, or following direct trauma. They are also more common in people with relatively weak or tight calf muscles.
Symptoms of an Achilles tendon rupture often include sudden, severe pain in the heel or lower leg, an audible cracking sound at the time of injury, an inability to walk normally or stand on tiptoes. feet, as well as swelling and hematoma (bruising) around the affected area.
Treatment for a ruptured Achilles tendon may require surgery to repair the torn tendon, followed by rehabilitation and physical therapy to restore normal strength and function to the tendon. In some cases, non-surgical treatment may be considered, but this will depend on various factors such as the severity of the rupture and the patient’s lifestyle.
WHY AN OPERATION?
Surgery is often recommended to treat a ruptured Achilles tendon due to several factors:
- Better Repair : Surgery generally allows for a more precise repair of the Achilles tendon, which can help restore its function and strength more effectively. By repairing the tendon anatomically, we promote strong and lasting healing.
- Reduced risk of recurrence : Studies show that people treated surgically tend to have a lower risk of recurrence of Achilles tendon rupture compared to those who opt for non-surgical treatment.
- Restoration of normal function : Surgery followed by appropriate rehabilitation can help restore normal strength and function to the Achilles tendon, allowing the patient to return to normal physical activity or even a level of performance comparable to that of before the injury.
- Adaptation to individual needs : The operation allows surgeons to tailor treatment based on each patient’s specific needs, including severity of the rupture, level of physical activity and recovery goals.
However, it should be noted that the decision to opt for surgery or non-surgical treatment will depend on various factors, including the severity of the rupture, the patient’s age and general health, and personal preferences. In some cases, non-surgical treatment may be effective, but it is important to consult a healthcare professional for advice tailored to the individual situation.
ACHILLES TENDON REPAIR
Achilles tendon repair is a surgical procedure that aims to reconnect the torn ends of the tendon to restore its continuity and function. Here is a general overview of the Achilles tendon surgical repair process:
- Anesthesia : Before surgery, the patient is usually put to sleep under general or regional anesthesia, depending on the surgeon’s and patient’s preferences.
- Positioning : The patient is placed in a prone or lateral position, depending on the surgical technique chosen by the surgeon.
- Incision : The surgeon makes an incision on the back of the leg, at the level of the Achilles tendon, to expose the area of the rupture.
- Tendon Repair : The torn ends of the tendon are identified and prepared for repair. Depending on the surgical technique used, the tendon may be repaired using sutures, fixation devices, or other methods to reconnect the tendon fibers.
- Reinforcement : In some cases, the surgeon may strengthen the repair by using tendon grafts from other parts of the body or synthetic materials to support the tendon while it heals.
- Closing the incision : Once the repair is complete, the incision is closed with sutures or staples and a dressing is applied.
- Rehabilitation : After surgery, the patient is generally required to follow a rehabilitation program supervised by a physiotherapist. This program may include strengthening, stretching, and functional rehabilitation exercises to help restore strength, mobility, and function to the Achilles tendon.
It is important to carefully follow the postoperative instructions provided by the medical team to promote optimal recovery and minimize the risk of complications.
In the event of a fresh lesion in the tendon body, a simple repair of the tendon is carried out.
A small surgical approach of a few centimeters is centered on the lesion.
- Wires will be passed through the tendon on either side of the break (Figure n°1) to bring the edges together and repair the tendon securely.
- Additional sutures will then be made to harmonize the contact between the banks (Figure n°2).
In the event of a fresh lesion in the myotendinous area, the reestablishment of contact between the muscle and the tendon is ensured by a device called Tenolig.
This procedure is done percutaneously, that is to say by making small incisions of a few millimeters.
- Two wires, each connected to a harpoon, are passed first through the muscle then through the rupture area and finally through the tendon to emerge through the skin (Figure n°3).
- The wires are then stretched, the harpoons are then anchored in the muscle allowing the banks to come together (Figure n°4).
At the end of the procedure, the threads are tied as they exit the skin on a button in order to maintain fixation.
In the event of an old injury, tendon reconstruction surgery is necessary to fill the loss of substance between the edges.
A more extensive surgical approach is then necessary.
- A tendon strip is taken upstream of the lesion and turned over on itself (Figure n°10).
- It is then sutured securely with threads to the lower bank (Figure n°11).
The sample site is closed at the end of the procedure, and will heal and strengthen over time.
The procedure lasts on average 1 hour. It requires hospitalization for approximately 3 days.
It can be performed under spinal anesthesia or under general anesthesia.
It is your anesthesiologist who decides with you the best anesthesia based on your state of health.
After the operation, a splint and then a resin boot are made.
Pain treatment will be implemented, monitored and adapted very closely in the post-operative period.
POST-OPERATIVE REHABILITATION AND RETURN TO ACTIVITIES
You will wear the resin cast for 6 weeks. You will have crutches to help you move around throughout this period, putting no weight on your foot.
When the cast is removed, you will walk with a heelpiece of which the thickness is progressively decreased over 3 weeks. The rehabilitation will then begin at your physiotherapist’s. Normal walking is recovered at the end of the 2nd month.
Driving and returning to work can be envisaged in the 3rd month, depending on your profession; office work can be sooner.
You can resume gentle sports activities like cycling and swimming after the 3rd month. Running can be envisaged after the 6th month. It may be necessary to wait until the 8th month before a return to team sports and competition.
RISKS AND COMPLICATIONS
In addition to the risks associated with any surgery and the anaesthetic, there are some risks specific to this surgery :
- The skin may not heal well and require nursing care for several weeks, or even surgical revision.
- The occurrence of an infection, although rare (risk below 1 % in our establishment), is a serious complication and may require surgical revision and a course of antibiotics.
- A haematoma may appear around the area operated on due to bleeding. According to the extent of the bleeding, drainage may be necessary.
- The nerves and arteries around the ankle may be damaged accidently. This exceptional complication may cause pain, loss of feeling and even paralysis of certain parts of the foot. In the event of arterial damage, vascular surgery may be necessary.
- Small blood clots can form and block the veins in the legs resulting in phlebitis, which will require an anti-coagulant treatment for several weeks.
- Joint stiffness can develop if the post-operative rehabilitation is not carried out properly.
- Exacerbated inflammatory reactions can result in adhesions and limit ankle mobility. However, new treatments exist that can help manage this rare complication more easily.
This list of risks is not exhaustive. Your surgeon can provide you with any additional explanations and will be available to discuss the advantages, disadvantages and risks of each specific case with you.
THE EXPECTED RESULTS OF YOUR OPERATION
In the context of a fresh rupture, the rate of tendon healing is over 95 %. The tendon is sometimes thicker. The risk of another rupture is below 5 %.
In the case of an old rupture, the rate of healing is pretty much the same but takes longer, thus delaying the return to activities.
The results of surgical repair of the Achilles tendon are nevertheless very encouraging as in over 90 % of cases patients return to sports activities at their previous level.
