Name of the Procedure:

Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)

Summary

This procedure involves surgically repairing a ruptured Achilles tendon using a graft, which can be obtained from the patient's own body or a donor. The repair can be done through an open surgery or a less invasive percutaneous method.

Purpose

The primary purpose of this procedure is to repair a torn Achilles tendon to restore normal foot function and prevent long-term mobility issues. The expected outcome is to bring the tendon back to its pre-injury state, allowing the patient to resume daily activities and physical exercise.

Indications

• Sudden onset of severe pain in the heel or calf, often accompanied by a "popping" sound.
• Difficulty or inability to point the toes downward.
• Swelling, bruising, and weakness in the lower leg.
• Diagnosis of a complete or partial Achilles tendon rupture, confirmed by physical examination and imaging tests.

Preparation

• The patient may need to fast for at least 8 hours before the surgery.
• Medications such as blood thinners may need to be adjusted or stopped.
• Preoperative imaging tests like ultrasounds or MRIs to assess the extent of the tendon injury.

Procedure Description

1. The patient is typically given general anesthesia or regional anesthesia (spinal or epidural).
2. An incision is made over the site of the rupture (for open surgery) or small punctures are made (for the percutaneous method).
3. The torn ends of the Achilles tendon are identified and sutured back together.
4. A graft, which could be taken from the patient (autograft) or a donor (allograft), is used to reinforce the repair.
5. The incision is closed using stitches, and the area is bandaged and immobilized.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

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

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Common risks: Infection, blood clots, and postoperative pain.
• Rare risks: Nerve damage, tendon re-rupture, graft rejection, and complications related to anesthesia.
• Management includes antibiotics for infections, medications to manage pain, and physical therapy to aid recovery.

Benefits

• Restoration of normal tendon function and strength.
• Increased likelihood of returning to pre-injury level of activity.
• Reduced risk of further tendon damage.

Recovery

• Initial immobilization with a cast or brace for about 6-8 weeks.
• Gradual weight-bearing exercises and physical therapy starting a few weeks post-surgery.
• Full recovery typically takes 4-6 months, but this can vary based on the individual's condition and adherence to rehabilitation protocols.

Alternatives

• Non-surgical treatment using a cast or brace to immobilize the foot.
  • Pros: Avoids risks of surgery.
  • Cons: Higher likelihood of re-rupture and longer recovery time.
• Minimally invasive procedures without a graft.
  • Pros: Shorter surgery time and less scarring.
  • Cons: May not be suitable for severe ruptures.

Patient Experience

• During the procedure: The patient will be under anesthesia and should not feel any pain.
• After the procedure: Pain and swelling in the lower leg, which can be managed with pain medications and ice therapy.
• Pain management typically involves prescribed painkillers and over-the-counter anti-inflammatory medications. Follow-up appointments will monitor the healing process and adjust care as needed.