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Procedure

Achilles Tendon Repair Technique

There are many Achilles Tendon Repair Techniques used by orthopedic surgeons, in this article we will explain the most common Achilles tendon surgery types.

See Also: Achilles Tendon Injection

Achilles Tendon Repair Technique Steps

  • Position the patient prone.
  • Make a posteromedial longitudinal incision, approximately 10 to 15 cm long, about 1 cm medial to the tendon. Ensure the incision ends just proximal to where the shoe counter strikes the heel. This off-center incision prevents future irritation from shoes directly over the tendon.
  • Make a sharp incision through the skin, subcutaneous tissues, and tendon sheath.
  • Reflect the tendon sheath along with the subcutaneous tissue, minimizing subcutaneous dissection.
  • Approximate the ruptured ends of the tendon using a No. 5 nonabsorbable tension suture. Use a modified Kessler stitch through the stump, 2.5 cm from the rupture. Plantar flex the foot 0 to 5 degrees, flex the knee 15 degrees, and tie the tension suture to approximate the tendon ends.
  • Use a tendon stripper to harvest the plantaris tendon, releasing it proximally. Keep it aside in a moist sponge.
  • Reposition the frayed ends of the tendon as close to their normal position as possible. Repair the rupture by using multiple 2-0 absorbable sutures both anteriorly and posteriorly.
  • Thread the previously harvested plantaris tendon into a fascial needle. Pass it circumferentially, first through the posterior and then through the anterior part of the tendon, 2 cm from the rupture.
  • Secure the plantaris tendon to the Achilles tendon using multiple 2-0 absorbable sutures. If the distal tendon is long enough, fan it out and tack it over the repair, following Lynn’s technique.
  • Close the fascial sheath and subcutaneous tissues using 2-0 absorbable sutures.
  • Close the skin and apply a sterile dressing.
  • Apply a short-leg cast with the foot in gravity equinus position.
See Also: Achilles Tendinitis | Causes & Treatment
Achilles Tendon Repair Technique Steps
Achilles Tendon Repair Technique

Achilles Tendon Repair Krackow Technique

  • With the patient prone, make a posteromedial incision approximately 10 cm long about 1 cm medial to the tendon and ending proximal to where the shoe counter strikes the heel.
  • Sharply dissect through the skin, subcutaneous tissues, and tendon sheath. Reflect the tendon sheath with the subcutaneous tissue to minimize subcutaneous dissection.
  • Approximate the ruptured ends of the tendon with a 2-0 nonabsorbable suture
  • Check the repair for stability after the sutures are tied.
  • Close the peritenon and subcutaneous tissues with 4-0 absorbable sutures.
  • Close the skin, and apply a sterile dressing and a posterior splint or short-leg cast with the foot in gravity equinus.
See Also: Achilles Tendon Rupture Tests
Achilles Tendon Repair Krackow Technique

Achilles Tendon Repair Lindholm Technique

  • With the patient prone, make a posterior curvilinear incision extending from the midcalf to the calcaneus.
  • Incise the deep fascia in the midline, and expose the tendon rupture. 
  • Débride the ragged ends of the tendon, and appose them with a box type of mattress suture of heavy nonabsorbable suture material or wire; also use fine interrupted sutures 
  • Fashion two flaps from the proximal tendon and gastrocnemius aponeurosis, each approximately 1 cm wide and 7 to 8 cm long. Leave these flaps attached at a point 3 cm proximal to the site of rupture.
  • Twist each flap 180 degrees on itself so that its smooth external surface lies next to the subcutaneous tissue as it is turned distally over the rupture. 
  • Suture each flap to the distal stump of the tendon and to one another so that they cover the site of rupture completely. 
  • Close the wound, being careful to approximate the tendon sheath over the site of repair.
Achilles Tendon Repair Lindholm Technique

References & More

  1. Campbel’s Operative Orthopaedics 12th edition Book.
  2. Gupta S, Salwan A Jr, Pisulkar GL, Saoji A, Taywade S. Surgical Repair of Achilles Tendon Rupture by Turn-O-Plasty: A Case Report. Cureus. 2022 Sep 11;14(9):e29058. doi: 10.7759/cureus.29058. PMID: 36249636; PMCID: PMC9554371. Pubmed
  3. Xu L, Jin J, Liu Z, Wu M, Peng B, Jiang J, Liu G, He J, White S, Xia Y. A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini-incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study. Orthop Surg. 2023 Feb;15(2):517-524. doi: 10.1111/os.13615. Epub 2022 Dec 26. PMID: 36573277; PMCID: PMC9891928. Pubemd
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