Surgery for Achilles Tendon Ruptures

Reconstructive surgery for a ruptured Achilles tendon is a popular option especially with younger, more active patients although more recently non operative treatment is being considered for all patients.

What does Achilles surgery involve?

When the Achilles tendon suffers a complete rupture there are two choices for treatment. The conservative route, which involves initial immobilisation to allow the tendon to heal, followed by strengthening and improving flexibility.

The other option is to go down the surgical route, and have the tendon repaired. There are two types of Achilles tendon surgery currently available:

Open Surgery: Here the surgeon makes a single large incision down the back of the calf allowing access for the tendon to be reattached. This method is associated with a 27% lower risk of repeated rupture, although an 11% risk of complications such as infection and adhesions.

Percutaneous Surgery: Involves several small incisions through which the Surgeon reattaches the tendon. This technique has demonstrated higher re-rupture rates and a higher occurrence of nerve damage, although has a lower chance of resulting in infection.

Post-Op

After Achilles Tendon Surgery The post-operative period varies between surgeons. A period of immobilisation of 6-12 weeks has previously been favored.

Usually a cast or walking boot is provided to support the ankle and prevent movement. The cast is initially set to keep the ankle in a position of plantarflexion (the shortest position for the Achilles tendon), allowing the tendon to heal.

The cast is then gradually adjusted to bring the foot into a neutral position and lengthen the tendon. However many Surgeons are now beginning mobilisation a lot earlier (1-2 weeks) in order to prevent the tendon becoming stiff and weak.

Movement helps to decrease swelling and orientation of the new tendon fibres being laid down, resulting in a higher tensile strength. Exercises begin with simply circling the ankle joint, increasing the size of the circles. Stretches are then introduced, followed by strengthening with resistance bands before weight bearing exercises are commenced.