Achilles tendon repair-open 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.
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Question 1 of 14
Which one of the following is the most dependable (though not necessarily diagnostic) physical sign in a patient with an Achilles rupture ?CorrectIncorrect
Question 2 of 14
Which one of the following statements is true of imaging with respect to an injured Achilles tendon ?CorrectIncorrect
Question 3 of 14
Which one of the following is true about the clinical findings of a patient with an Achilles rupture?CorrectIncorrect
Question 4 of 14
With respect to the symptoms and effects of an Achilles rupture which one of the following is not true ?CorrectIncorrect
Question 5 of 14
Which one of the following patients would be most appropriately treated by a direct Achilles tendon repair ?CorrectIncorrect
Question 6 of 14
Which one of the following is correct about a direct “end to end” surgical repair of an Achilles tendon ruptureCorrectIncorrect
Question 7 of 14
Which one of the following is true of a direct posterior approach onto the Achilles tendon ?CorrectIncorrect
Question 8 of 14
If dissecting deep (anterior) to the Achilles tendon which one of the following is true ?CorrectIncorrect
Question 9 of 14
When suturing the Achilles tendon which one of the following is true ?CorrectIncorrect
Question 10 of 14
If the tendon ends do not oppose with the ankle positioned in neutral during an Achilles repair which one of the following is the most appropriate course of action ?CorrectIncorrect
Question 11 of 14
Which one of the following is true about how to proceed once the tendon sheath has been opened ?CorrectIncorrect
Question 12 of 14
If calf swelling increases at 4 weeks post-operatively following Achilles tendon repair which one of the following is the most appropriate action ?CorrectIncorrect
Question 13 of 14
After 7 weeks post-operatively (during the rehabilitation phase) which one of the following is true ?CorrectIncorrect
Question 14 of 14
Which one of the following statements about the published results of Achilles tendon ruptures is incorrect ?CorrectIncorrect