Achilles Rupture Surgery – Relevant Anatomy
The achilles tendon is the thickest tendon in the body. It is the tendon at the back of the leg that connects the calf muscles (Gastrocnemius and Soleus) to the Heel bone (Calcaneus).
There are 3 possible sites of achilles tendon ruptures:
Watershed Zone
This is the most common site of tendon rupture and is located 3-5 cm above the achilles tendon insertion into the heel bone (calcaneus). The term ‘watershed’ is used to describe the region of tendon with poor bloody supply – predisposing to tendon rupture.
Insertion of tendon into calcaneus
This is a less common location for an achilles rupture. In this scenario, the achilles tendon ruptures directly off its insertion into the heel bone (calcaneus). This is typically seen in patients with underlying achilles tendinosis.
Musculotendinous Junction
Achilles ruptures in this area occur closer to the calf muscle bellies. This are best managed non-operatively with functional rehabilitation in combination with a dedicated rehabilitation team.
Achilles Rupture – tendon repair – Minimally invasive
All Achilles ruptures require a thorough assessment to achieve an optimal outcome.
Dr. Smith surgically manages an acute achilles rupture / tear using the latest minimally invasive techniques. The majority of achilles ruptures occur at the ‘watershed’ zone of the tendon, and are amenable to this technique.
You will arrive at the hospital on the day of your procedure and be met by the anaesthetist and the friendly theatre staff. Your anaesthetist will discuss with you the best analgesic options following the procedure.
The technique itself, involves making a small horizontal incision at the level of the achilles rupture, on the back of the calf. A specialised ‘jig’ is passed through this small incision, and used to secure the proximal (top) part of the tendon with sutures. These sutures are retrieved through the distal (bottom) part of the achilles tendon, and secured into the heel bone via the use of specialised anchors . This achieves very strong fixation of the sutures, and allows for early mobility.
Your are placed into a postoperative boot and offered a set of crutches for comfort. You are able to commence early weight bearing in the boot.
This procedure is frequently performed as a day procedure, and you will be seen again by Dr. Smith in his rooms, 2 weeks following the procedure.
Surgical Treatment of Achilles tendinosis
Surgical management of achilles tendinosis / tendinitis is most frequently performed for patients suffering from insertional achilles tendinosis. There are multiple causes of ‘achilles pain’ experienced in this condition, and all of these aspects are addressed at the time of the procedure, through the same incision.
Achilles Tendinosis
With time, the lower end of the achilles tendon undergoes degeneration. At the time of the procedure, any degenerative tissue is removed, to alleviate this pain generator.
Haglund Deformity
A ‘Haglund deformity’ relates to excessive bone formation at the back of the calcaneus (heel bone). This can result in irritation of the achilles tendon itself, as well as the adjacent bursa (Retrocalcaneal Bursa). This can be particularly painful when rubbing on the back of shoes.
This excess bony lump is removed at the time of the procedure.
Retrocalcaneal Bursitis
The retrocalcaneal bursa sits behind the heel bone (calcaneus) and in front of the achilles tendon. Irritation of this ‘bursa’ results in pain at the back of the ankle. Inflamed tissue is removed at the time of the operation through the same incision.
The procedure involves making an incision directly ‘bony bump’ at the back of the heel. The achilles tendon is partially reflected from its insertion into the calcaneus (heel bone). Any diseased portions of the tendon are removed. The excessive bony bump is removed, as is the inflamed bursa. The achilles tendon is secure back to the calcaneus with strong suture anchors.
Achilles Surgery – Recovery and Rehabilitation
Dr. Smith uses surgical techniques that allow for early mobility and weight bearing. Weight bearing is commenced immediately with the addition of a postoperative boot.
Depending on any other risk factors that may be present, patients are typically commenced on aspirin to reduce the risk of developing a blood clot.
A wound review is performed 2 weeks following surgery, and a structured rehabilitation program is commenced with the support of dedicated sports physiotherapists.
Progressive range of motion exercises and a strengthening program is initiated.