From the Guidelines
Achilles tendon surgery is a viable treatment option for patients with acute Achilles tendon rupture, with surgical treatment being an option according to the Journal of the American Academy of Orthopaedic Surgeons 1. The procedure typically involves making an incision in the back of the lower leg to access the damaged tendon. The surgeon then sutures the torn ends of the tendon back together using strong stitches designed to withstand tension. In some cases, if the tendon damage is extensive, the surgeon may need to reinforce the repair with a tendon transfer from another part of the foot or leg. The surgery is usually performed under general or spinal anesthesia and takes about 30-60 minutes. Following surgery, the leg is immobilized in a cast or walking boot for 6-8 weeks to allow proper healing, with early protected weight bearing recommended within 2 weeks postoperatively 1. Physical therapy is essential after immobilization, typically lasting 3-4 months, to restore strength and flexibility. Patients usually take pain medications like oxycodone or hydrocodone for the first few days, then transition to over-the-counter options like acetaminophen or ibuprofen. Full recovery can take 4-6 months, with gradual return to normal activities, and for patients who participate in sports, it is an option to return them to sports within 3 to 6 months after surgical treatment 1. Surgery is necessary because the Achilles tendon rarely heals properly on its own due to poor blood supply and the constant tension placed on it during walking. Some of the surgical techniques used include open, limited open, and percutaneous techniques, with the choice of technique depending on the individual patient's needs and the surgeon's preference 1.
Key Points
- Surgical treatment is an option for acute Achilles tendon rupture 1
- Early protected weight bearing is recommended within 2 weeks postoperatively 1
- Return to sports is possible within 3 to 6 months after surgical treatment for patients who participate in sports 1
- The choice of surgical technique depends on the individual patient's needs and the surgeon's preference 1
From the Research
Overview of Achilles Tendon Surgery
Achilles tendon surgery is a procedure used to repair a ruptured Achilles tendon, which is a common injury that can occur during physical activity. The goal of surgery is to restore the tendon to its normal function and allow patients to return to their pre-injury activity level.
Types of Achilles Tendon Surgery
There are several types of Achilles tendon surgery, including:
- Open repair: This involves making an incision in the skin to access the tendon and repair it with sutures or other materials 2.
- Percutaneous repair: This involves making small incisions in the skin and using a special instrument to repair the tendon 2, 3.
- Non-operative treatment: This involves using a cast or functional brace to immobilize the tendon and allow it to heal on its own 4, 2.
Rehabilitation After Achilles Tendon Surgery
Rehabilitation after Achilles tendon surgery is an important part of the recovery process. Studies have shown that early ankle mobilization and full weight bearing can lead to better outcomes and faster recovery times 5. A rehabilitation protocol that includes immediate full weight bearing and controlled ankle mobilization after the second postoperative week can help patients return to their pre-injury activity level more quickly.
Complications and Risks
As with any surgical procedure, there are risks and complications associated with Achilles tendon surgery. These can include infection, wound complications, and rerupture of the tendon 6, 2, 3. However, studies have shown that the risk of complications can be minimized with proper surgical technique and post-operative care.
Anaesthesia Options
Achilles tendon surgery can be performed under general anaesthesia, spinal anaesthesia, or local anaesthesia. Studies have shown that local anaesthesia can be a safe and effective option for Achilles tendon repair, with fewer complications and a faster recovery time compared to general anaesthesia 6.
Treatment Outcomes
The outcome of Achilles tendon surgery can vary depending on the type of surgery and the individual patient. Studies have shown that surgical treatment can lead to better outcomes and faster recovery times compared to non-operative treatment, especially in patients with a high level of physical activity 5, 2, 3. However, the choice of treatment should be individualized based on the patient's specific needs and circumstances.