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Repair Achilles tendon ruptures without an open surgery

We repair Achilles tendon ruptures without an open surgery. Over the past 20 years,
we have optimized a technique allowing us to avoid making an open incision and
preserve the growth factors to speed healing and decrease infection. Our technique is
called Percutaneous Achilles Repair and works by passing sutures through the skin
and pulling the ruptured ends of the tendon together allowing the tendon to heal
back to its normal strength.

Treatment: Complete rupture

If the Achilles is completely ruptured, we prefer to not open the ruptured site. This is
because when an Achilles tendon ruptures, the body attempts to create a healing
environment and, as bleeding occurs within the sheath around the Achilles tendon, it
brings new cells to the injury site and starts the repair process. If you open the site,
the natural healing factors are then lost into the surgical incision. Open surgery also
leads to increased scarring and increased risk of infection.
The alternative to open surgical repair of the ruptured Achilles tendon is a
percutaneous repair of the ruptured tissue. This is accomplished by making a small
skin nick and passing sutures in a crisscross fashion, capturing the proximal and distal
aspects of the tendon and cinching them together. This closed technique permits
preservation of the natural growth factors and blood clot that forms around the
ruptured ends and facilitates healing with less scarring.
Our results of percutaneous Achilles tendon repair have been superb with only 6
traumatic re-ruptures in twenty years of repairs.
The benefits of percutaneous repair

No full incision

Reduced risk of infection

Less scarring

Less pain

No general anesthetic required

Shorter surgery

The tendon sheath, holding the blood clot that forms at the time of the tendon
rupture is kept intact, permitting rapid healing of the tendon.

The rehabilitation program is accelerated

Full return to sports is expected

Surgical technique
The proximal portion of the tendon, as identified by palpation and MRI, is captured
with a #1 Tevdek suture placed transversely through the skin and the tendon and out
the opposite side.

This suture is then crisscrossed through the tendon, the gap at the rupture site, and
finally through the distal portion of the tendon just above the calcaneus, through the
skin punctures.

A second stitch is placed after the first one and is tied with the foot in plantar
flexion. A dressing is applied and the foot is placed in a plantar flexed pre-formed
padded splint.