Name of the Procedure:

Repair, Primary, Open or Percutaneous, Ruptured Achilles Tendon

Common Name(s): Achilles Tendon Repair, Achilles Tendon Surgery
Technical/Medical Term: Tenorrhaphy (Achilles tendon)

Summary

Achilles tendon repair is a surgical procedure used to fix a ruptured Achilles tendon, which is the band of tissue connecting the calf muscles to the heel bone. The surgery can be done through open surgery or a minimally invasive method known as percutaneous repair.

Purpose

Medical Condition: Ruptured Achilles Tendon
Goals/Outcomes: To reconnect the torn ends of the Achilles tendon, restore functionality, and alleviate pain. The procedure aims for the patient to regain normal range of motion and strength in the affected leg.

Indications

Symptoms/Conditions:

• Sudden sharp pain in the back of the ankle or calf
• Swelling and bruising around the ankle
• Difficulty walking or inability to push off the foot or rise on the toes Patient Criteria:
• Complete rupture of the Achilles tendon diagnosed through clinical exams or imaging
• Active individuals or athletes who require full functionality of the leg

Preparation

Pre-Procedure Instructions:

• Fasting may be required if general anesthesia is used
• Adjustment of medications such as blood thinners as directed by the physician Diagnostic Tests/Assessments:
• Physical examination
• Imaging studies like ultrasound or MRI to confirm the rupture

Procedure Description

1. Anesthesia: Regional (spinal or epidural) or general anesthesia is administered.
2. Incision:
   • Open Repair: A single incision is made along the back of the lower leg.
   • Percutaneous Repair: Several small incisions are used to insert instruments.
3. Repair:
   • The ruptured ends of the tendon are sutured together using strong, non-absorbable sutures.
4. Closure:
   • Open Repair: The incision is closed with sutures or staples.
   • Percutaneous Repair: Small incisions are closed with sutures or adhesive strips.

Tools/Equipment: Scalpels, sutures, specialized surgical instruments for percutaneous repair

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

Involved Healthcare Professionals:

• Orthopedic surgeon or specialized foot and ankle surgeon
• Anesthesiologist
• Surgical nurses and scrub technicians

Risks and Complications

Common Risks:

• Infection
• Blood clots
• Nerve damage
• Scarring or adhesion formation Rare Risks:
• Tendon re-rupture
• Chronic pain
• Permanent loss of motor function Complication Management:
• Immediate medical attention and possible revision surgery if complications arise

Benefits

Expected Benefits:

• Relief from pain and discomfort
• Restoration of normal leg function
• Ability to return to daily activities and potentially sports Timeframe: Benefits can typically be realized within a few months post-surgery, following proper rehabilitation.

Recovery

Post-Procedure Care:

• Immobilization of the ankle with splints or casts for initial healing
• Pain management with prescribed medications
• Physical therapy to regain strength and flexibility Recovery Time: Full recovery can take 3 to 6 months, with gradual resumption of physical activities. Restrictions: Weight-bearing activities are limited initially; gradual return as advised by the healthcare provider Follow-Up: Routine check-ups with the surgeon and physical therapist

Alternatives

Other Treatment Options:

• Non-surgical treatment including immobilization with a cast or brace Pros and Cons:
• Non-Surgical Treatment: Lower risk of surgery-associated complications, but may have a longer recovery time and slightly higher risk of re-rupture

Patient Experience

During the Procedure:

• Patients will be under anesthesia and should not feel pain. After the Procedure:
• Pain and swelling around the incision site, managed with medications.
• Initial discomfort which improves with time and rehabilitation.
• Use of crutches or a walker during the early recovery phase to avoid weight-bearing on the affected leg.
• Physical therapy to aid in recovery and restore function.