How to diagnose Achilles tendon ruptures?

Patients usually present with acute and sudden pain behind the calf. Commonly, a feeling of “getting kicked” behind the heel is described. There is significant pain and weakness in flexing the ankle joint. Most orthopaedic surgeons will be able to diagnose an Achilles tendon rupture without further investigations. It is not uncommon that x-rays or MRIs are required in questionable cases.

What is the treatment of Achilles tendon ruptures?

Achilles tendon ruptures can be treated with a wide range of methods. Non-surgical treatment with functional rehabilitation is recommended in patients with low demand or having contraindications for surgery. The open repair can achieve a robust approximation of tendon ends but are fraught with wound complications in up to 1 in 3 cases. Minimally invasive treatments (MIS) for Achilles tendon rupture have been proposed to restore tendon integrity while avoiding extensive incisions associated with open repair.

What is a minimally invasive Achilles tendon repair (MIS)?

There are several options in the MIS approach for Achilles tendon repair. Special instruments such as Achillon or PARs jigs can be used but still require small 3-cm incisions. Arthroscopic technique for Achilles repair requires only 3-mm arthroscopic portals. The tendon is approximated using high-strength sutures under direct visualization so a robust repair is created while avoiding complications such as nerve damage.

What are the risks and benefits of MIS Achilles tendon repair?

Risks: scar pain, re-rupture, deep vein thrombosis, nerve irritation

Benefits: less postoperative pain, less scarring, fast recovery, fewer overall complications

What is the recovery after a MIS Achilles tendon repair?

The patient can go home on the same of surgery with a splint on the affected leg. The ankle will be immobilized without weight-bearing for the first 2 weeks. Progressive weight-bearing starts at 2 weeks in an adjustable walking boot and with crutches. The position of the ankle in the boot will be adjusted every two weeks until the patient can walk flat without crutches at 6 weeks. Patients can usually wean off from the boot by 8-10 weeks and return to sports at 12 weeks.

Author: Phinit Phisitkul, MD

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