Name of the Procedure:

Repair, secondary, Achilles tendon, with or without graft
Common terms: Achilles tendon repair, secondary repair of Achilles tendon rupture.

Summary

This surgical procedure is performed to repair a previously injured or ruptured Achilles tendon. The surgery can involve stitching the tendon back together or using a graft to reinforce the repair.

Purpose

The procedure addresses complications or re-injury of a previously ruptured Achilles tendon. The goal is to restore tendon functionality, improve mobility, and reduce pain or discomfort.

Indications

• Re-rupture of a previously repaired Achilles tendon
• Chronic Achilles tendon pain or dysfunction not responsive to conservative treatments
• Presence of scar tissue or significant defect in the tendon
• Inability to bear weight or walk normally due to tendon issues

Preparation

• Pre-surgery fasting (typically 8-12 hours)
• Adjusting or temporarily discontinuing certain medications like anticoagulants
• Pre-operative blood tests and imaging studies such as MRI or ultrasound
• Pre-anesthetic assessment if general anesthesia is to be used

Procedure Description

1. Anesthesia: General anesthesia or local anesthesia with sedation will be administered.
2. Incision: A surgical incision is made over the Achilles tendon.
3. Repair: The tendon is exposed, and scar tissue or damaged portions are removed. Sutures are used to stitch the tendon ends together. If a graft is used, tissue from another part of the body or a synthetic graft is secured to reinforce the repair.
4. Closure: The incision is closed with sutures or staples and a sterile dressing is applied.
5. Immobilization: The foot and ankle may be placed in a cast or boot to immobilize the area and aid healing.

Duration

The procedure typically takes 1 to 2 hours to complete.

Setting

This surgery is usually performed in a hospital operating room or a specialized outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical assistants or nurses
• Anesthesiologist
• Scrub nurse or surgical technologist

Risks and Complications

• Infection
• Nerve damage
• Blood clots
• Re-rupture of the tendon
• Prolonged healing time

Benefits

• Improved tendon strength and function
• Alleviation of pain and discomfort
• Enhanced mobility and ability to perform daily activities
• Short-term benefits may be felt within weeks, with full recovery taking several months.

Recovery

• Initial immobilization in a cast or boot for 6-8 weeks
• Gradual weight-bearing and physical therapy
• Follow-up appointments to monitor healing
• Full recovery may take 3-6 months, with activity restrictions as advised by the surgeon

Alternatives

• Conservative treatments such as physical therapy, bracing, or orthotics
• Primary repair procedures if the initial rupture is recent
• Non-operative management for partial tears or minor injuries

Patient Experience

• The patient may experience discomfort and swelling around the surgical site.
• Pain management includes medications prescribed by the surgeon.
• The patient will need assistance with mobility initially and must follow specific care instructions to avoid complications and promote healing.