Achilles tendon rupture: Open repair technique
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A surgical repair of the Achilles tendon is required in the active patient in whom the tendon ends are demonstrated not to be in adequate apposition(under ultrasound imaging) when the ankle is placed into full equinus.
Another indication for surgical repair of the ruptured Achilles tendon is a delayed presenting Achilles rupture, irrespective of how well tendon ends appose. The definition of delayed here is open to interpretation though numbers in weeks. In this scenario the repair may need to by augmented by some form of tendon transfer. One example if the Flexor Hallucis tendon transfer which can be read on Achilles Reconstruction :Flexor Hallucis Longus tendon transfer using Arthrex Biotenodesis screw . Apart from these situations most cases are open to debate.
Recognition has increased over recent years that these injuries are associated with an increased risk of DVT, so appropriate prophylaxis should be used and calf symptoms investigated aggressively.
Operative alternatives to the open technique are percutaneous repairs using purpose designed jigs such as the Integra Achillon which is detailed at Integra Achillon to repair Achilles rupture
Author: Mark Herron FRCS.
Institution: The Wellington Hospital, London,UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.
In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu
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