Achilles tendon repair-open technqiue surgical technique
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CPD/CME Points: 1
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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.
Apart from these situations most cases are open to debate.
Recognition has increased over recent years that these injuries (as well as the immobility associated with this) 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 Achillon, described elsewhere in Orthoracle.
Author: Mark Herron FRCS
Institution: The Wellington Hospital , London ,UK.