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 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 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.

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