A loud pop, a feeling of being kicked in the back of your ankle and a feeling of weakness in the leg: You’ve just ruptured your Achilles tendon. If you’re an athlete, you’re done for the day—maybe even the season. If it happened at work, you’re looking at disability.
Achilles tendon ruptures and their cousin, Achilles tendinitis (or tendinopathy), are common among athletes and active people. The feet of athletes and of people with physical jobs typically take a beating. Achilles tendinitis is a chronic condition in which the Achilles tendon gradually degrades. This makes it more likely for the tendon to tear (also known as rupture).
When the Achilles tendon is torn, you’ll have a few options for treatment. Mild tears often heal with nonsurgical methods, but a full tear will probably need surgery. In the past, that surgery was done as an open procedure: with a comparatively large incision to open the skin so the surgeon could see what he or she is doing.
However, evidence is mounting that minimally invasive surgery can be a better option for some patients. This involves small incisions, small tools and less scarring than traditional open surgery. Research suggests that minimally invasive surgery can repair a torn Achilles tendon with less pain, a shorter hospital stay and faster recovery.
What Is the Achilles Tendon?
Tendons are tissue that connect muscles to bones. The Achilles tendon, then, connects the muscles of the calf (the gastrocnemius and the soleus) to the heel bone (calcaneus).
The Achilles tendon is subject to a remarkable amount of stress, especially for recreational athletes. Any sport that involves jumping increases the risk of a torn Achilles, as does any sport that requires sudden stops and starts. That includes:
…and others. Certain other factors can weaken the Achilles tendon or make it more susceptible to rupture, such as:
- Age—being between the ages of 30 and 40
- Sex—being male
- Previous corticosteroid injections
- Antibiotics in the fluoroquinolone family, such as ciprofloxacin and levofloxacin
Surgery for Torn Achilles Tendons
The severity of the tear, as well as how active the patient is, can help me determine if the patient will benefit from nonoperative treatment or if he or she should have surgery. I always try to start with conservative treatment, but full tears may require surgery, and if an athlete wishes to return to his or her sport faster, surgery may sometimes (not always) be the best way to do so.
Open surgery is the traditional method of repairing a torn Achilles tendon. A surgeon makes a single incision an average of 10 cm long through the skin, muscle and tendon sheath. Surgeons often use a technique called a Krackow stitch or Krackow suture, where the tendon is stitched up and down on both sides of the rip, to repair the torn tendon.
This surgery is effective, but recovery time can be drawn-out and there’s a risk of complications such as scar formation. A minimally invasive approach can reduce both risks and recovery time.
Minimally Invasive Achilles Tendon Surgery
Minimally invasive Achilles tendon repair is done with a 1-cm incision. Surgeons pass a suturing device through the incision and suture the ruptured tendon back together. One advantage of using a minimally invasive technique—sometimes known as percutaneous Achilles repair system (PARS) technique—is that it can preserve more Achilles tendon tissue.
In a traditional open surgery, the tendon is debrided first, which means stray tendon fibers are cleaned up. This creates two clean ends of the ruptured tendon for the surgeon to sew back together. With PARS, the surgeon is able to work around the stray tendon fibers and start the repairs from the healthy part of the tendon, which researchers think may promote faster healing.
A 2018 meta-analysis rounded up studies comparing minimally invasive and traditional Achilles tendon repairs. The analysis found two distinct advantages to minimally invasive surgery. First, minimally invasive surgery has a significantly lower wound infection risk compared to traditional open surgery. Fewer complications may mean a faster recovery time.
Just as important, patients love the results of minimally invasive surgery. Patients in the meta-analysis were more likely to rate the results as good or excellent. When patients are happy with their surgery and their function returns, I know I’ve done my job as a surgeon.
If you have had an Achilles tendon rupture, request an appointment with me or one of my colleagues. We’ll be able to develop a treatment plan that’s right for you and put you on the road to recovery.