What is Percutaneous Achilles Repair?
Percutaneous Achilles repair is a minimally invasive surgical procedure to treat an Achilles tendon tear. The procedure involves making several small surgical incisions behind the ankle and stitching back together the two torn pieces of the Achilles tendon, instead of making one large incision as in an open surgery and carrying out the repair. The main objective of percutaneous Achilles repair is to minimize soft tissue dissection while restoring normal foot function.
Anatomy of the Achilles Tendon
Tendons are the soft tissues connecting muscle to bone. The Achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscles tightens the Achilles tendon and pulls the heel, enabling the foot and toe movements necessary for walking, running, pivoting, and jumping.
A tear or rupture of the Achilles tendon is commonly seen in middle-aged individuals involved in sports activities. The tendon may rupture due to weakness as a result of advanced age or from sudden bursts of activity during sports such as tennis, badminton and basketball.
Indications for Percutaneous Achilles Repair
If your Achilles tendon is ruptured, you will experience severe pain in the back of your leg, swelling, stiffness, and difficulty standing on tiptoe and pushing the leg when walking. A popping or snapping sound is heard when the injury occurs. You may also feel a gap or depression in the tendon, just above your heel bone. Your surgeon may recommend a percutaneous Achilles repair when non-surgical remedies such as medications, physical therapy, or wearing a cast or special brace have failed to resolve your symptoms.
Preparation for Percutaneous Achilles Repair
Preoperative preparation for percutaneous Achilles repair may involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements you are taking.
- You may need to stop taking supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Percutaneous Achilles Repair
The procedure for percutaneous Achilles tendon repair will involve the following steps:
- You will be placed on the operating table in a face-down position with the foot to be treated hanging over the end to allow access to the back of the ankle.
- You will be typically administered regional or general anesthesia.
- Your surgeon makes 3 small incisions at the back of the ankle along the Achilles tendon, and the tear is exposed.
- Care is taken to avoid any harm to surrounding structures such as nerves and vessels.
- Your surgeon will pass sutures in a crisscross fashion, capturing the proximal and distal aspects of the tendon and cinching them together.
- Your surgeon will stitch the torn tendon back together by passing sutures in a crisscross fashion, capturing the distal and proximal aspects of the tendon and securing them together.
- Your surgeon may reinforce the Achilles tendon with other tendons depending on the extent of the tear.
- If the tendon has avulsed or pulled off the heel bone, your surgeon will reattach the tendon to the heel bone.
- Finally, the incisions are closed with sutures, and the ankle is immobilized in a cast to facilitate healing.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after percutaneous Achilles repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
- You may apply ice bags over a towel to the affected area for about 15-20 minutes to reduce postoperative pain and swelling.
- You will be prescribed medications for pain relief and for prevention of deep vein thrombosis (DVT) as needed.
- You will be provided with crutches to ambulate safely as soon as you feel comfortable.
- The sutures and cast are removed after two weeks and you will be transitioned into a CAM boot with heel raises/wedges.
- Rehabilitation (physical therapy exercises) will be started to strengthen ankle muscles and optimize foot function.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 3 months. A gradual increase in activities over a period of time is recommended.
- You may return to sports once the foot has regained its normal strength and function, and with your surgeon's approval.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Percutaneous Achilles Repair
Some of the benefits of percutaneous Achilles tendon repair over traditional open surgery include:
- Minimal muscle trauma
- Reduced risk of re-rupture
- Less pain
- Less scarring
- Shorter surgery
- Faster healing of the tendon
- Minimal risk of infection
- Accelerated rehabilitation program
- Shorter hospital stay
- Quicker recovery
- Full return to sports activities
Risks and Complications
Percutaneous Achilles repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Damage to surrounding structures
- Thromboembolism or blood clots
- Anesthetic/allergic reactions
- Persistent pain
- Loss of foot function
- Muscle weakness
- Wound dehiscence