CME OnDemand: 2022 AOFAS Annual Meeting-Limited Open Achilles Repair without Instrument Guided Assistance: A Surgical Technique

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Achilles tendon injuries are a common occurrence during recreational sports, making up about 20% of all large tendon injuries. These injuries have a higher prevalence in men and typically occur between the ages of 25 to 40 and over 60 years old. A limited open Achilles tendon repair technique has gained popularity as a treatment option for acute ruptures. This technique involves a surgical repair without the use of instrument guidance.<br /><br />The surgical procedure begins with a posterior midline approach and a longitudinal incision over the rupture site. The proximal and distal stumps of the tendon are identified and sutures are passed horizontally through these areas. The sutures are marked differently to ensure proper alignment during the repair. The posterior compartment is released to reduce tension on the repair site. The sutures are then tied together, followed by a running box suture around the rupture site. After the repair site is irrigated and closed, postoperative pain control is provided using liposomal bupivacaine.<br /><br />The postoperative management and rehabilitation process involves non-weight-bearing in a splint for the first two weeks, followed by the use of a walking boot with gradual weight-bearing. Active dorsiflexion is allowed, but plantarflexion is restricted. Proprioceptive exercises and progression to standing bilateral heel raises are introduced between weeks 6 and 10. Return-to-sport varies, with most patients returning to their previous level of activity in 5.6 months on average.<br /><br />A case series of patients who underwent this limited open Achilles tendon repair technique showed positive outcomes. There were no wound complications, re-ruptures, or re-operations observed. Patients experienced significant improvements in pain scores and foot and ankle function. Nonoperative indications for Achilles tendon injuries include delayed presentation, infections, compromised soft tissue, and comorbidities such as diabetes and obesity.<br /><br />Overall, the limited open Achilles tendon repair technique offers improved clinical outcomes for patients while reducing reliance on operative equipment, cost, and surgical duration.

Asset Subtitle

Aman Chopra, BA, Aarav S. Parekh, Selene G. Parekh, MD, MBA

Keywords

Achilles tendon injuries

recreational sports

large tendon injuries

men

age

limited open Achilles tendon repair technique

surgical repair

instrument guidance

postoperative management

rehabilitation process