A Closer Look At Mini-Incision Repair Of The Acute Achilles Tendon Rupture

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Author(s): 
Samantha Bark, DPM, Meagan M. Jennings, DPM, FACFAS, and Shannon M. Rush, DPM, FACFAS

   The patient should remain non-weightbearing until the first post-op visit at 12 to 14 days. The patient may begin protected, 50 percent weightbearing in a removable cast boot with an appropriate heel lift and begin physical therapy at two weeks. Physical therapy can progress as the patient tolerates. Return to activity ranges between five to nine months.

In Conclusion

Minimal incision Achilles tendon repair is indicated for acute mid-substance ruptures. It is not indicated in ruptures at the musculotendinous junction, avulsions involving bone, re-ruptures or chronic ruptures. It also requires the distal portion of the tendon to be a minimum of 2 cm in length. The minimal incision approach allows for direct visualization of the apposition of the tendon ends upon knot tying as opposed to the purely percutaneous methods. This helps to minimize gapping and scar formation.

   Other benefits include a decrease of subcutaneous tendinous adhesions and increased preservation of the blood supply to the Achilles tendon.1 In theory, the preservation of the blood supply should decrease the risk of re-rupture and aid in a quicker recovery. Since a tourniquet is not necessary and rarely used for the mini-open repair, there may be a decrease in the risk of postoperative thromboembolic events.

   There are many studies comparing the different methods of Achilles tendon rupture treatments. While surgical techniques vary from the incision length to the length of the operation to tourniquet use to suture material and suture technique, it seems that the real variable is the postoperative treatment of when physical therapy starts and how aggressively it progresses.

   Dr. Bark is a fellow in limb lengthening and deformity correction at the Rubin Institute for Advanced Orthopedics in Baltimore.

   Dr. Jennings is affiliated with the Department of Orthopedics and Podiatry at the Palo Alto Medical Foundation in Mountain View, Calif. She is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Rush is affiliated with the Department of Orthopedics at the Palo Alto Medical Foundation in Mountain View, Calif. He is a Fellow of the American College of Foot and Ankle Surgeons.

References

1. Soubeyrand M, Serra-Tosio G, Campagna R, Molina V, Sitbon P, Biau DJ. Intraoperative ultrasonography during percutaneous Achilles tendon repair. Foot Ankle Int. 2010;31(12):1069-74.
2. Chan KB, Lui TH, Chan LK. Endoscopic-assisted repair of acute Achilles tendon rupture with Krackow suture: an anatomic study. Foot Ankle Surg. 2009;15(4):183-6.
3. Mukundan C, El Husseiny M, Rayan F, Salim J, Budgen A. “Mini-open” repair of acute tendo Achilles ruptures--the solution? Foot Ankle Surg. 2010;16(3):122-5.
4. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81(7):1019-36.

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