Minimally Invasive Achilles Repair

What is Minimally Invasive Achilles Repair?

Minimally invasive Achilles repair is a surgical technique used to treat a tear or rupture of the Achilles tendon using a small incision. A traditional open surgery for repair of the Achilles tendon tear would involve making a larger incision of 10 cm long (about 4 inches) in order to fully expose the torn tendon ends and repair them. On the contrary, minimally invasive Achilles repair involves making a small incision of 2 to 3 cm long (1 inch) at the rupture site in the back of the calf and using a special device to capture and sew the torn ends of the Achilles tendon.

The Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone. It is used when you walk, run, and jump. Achilles tendon rupture occurs most often in middle-aged athletes participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause an Achilles tendon rupture include tennis, racquetball, basketball, and badminton. 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.

Indications for Minimally Invasive Achilles Repair

Your surgeon may recommend minimally invasive Achilles repair to treat an Achilles tendon injury in the following scenarios:

• When the damage is severe
• For both partial and complete tears
• When non-surgical treatments such as medications and physical therapy have been ineffective
• You are an active individual or athlete who wants to return to sports at the earliest
• Your job requires strenuous physical activity and you wish to return to work sooner
• For individuals with Achilles tendinitis that has not healed with a comprehensive physical therapy program

Preparation for Minimally Invasive Achilles Repair

Preparation for minimally invasive Achilles repair may involve the following steps:

• A review of your medical history and physical examination is performed to check for any medical issues that need to be addressed prior to the surgery.
• You may also need to undergo diagnostic tests such as blood work to help detect any abnormalities that could compromise the safety of the procedure and imaging of the ruptured Achilles tendon area to plan the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of current medications or supplements you are taking, or any recent illnesses or conditions you have such as a heart or lung disease.
• Your physician may alter the dosage of your medications or ask you to stop taking certain medications, such as blood thinners for a defined period if contraindicated for the procedure.
• You should refrain from alcohol and tobacco for at least a few days prior to surgery and several weeks after, as these can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to the surgery.
• You should arrange for someone to drive you home after the procedure.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Minimally Invasive Achilles Repair

In general, minimally invasive Achilles repair will involve the following steps:

• You will be placed on the operating table in a face-down position to enable access to the back of the leg where the rupture has occurred.
• You will typically be administered a general or spinal anesthetic.
• The surgical site is cleaned with an antiseptic solution, and using a minimally invasive technique, an inch-long small incision is made where the tendon ends are located.
• The tendon sheath (paratenon) is carefully opened, and the ends of the torn tendon are then debrided and freed up.
• A specially designed stitch device is then passed up and around the tendon, which guides sutures (stitches) into the tendon and pulls them into the small incision.
• The sutures are then tied so the tendon ends meet, and when compared to the other leg, the foot and ankle should be in the same position. This means that the correct length of the tendon has been accomplished.
• The wound is then closed with sutures, and the ankle is immobilized in a cast or splint to facilitate healing.

Postoperative Care and Recovery

In general, postoperative care and recovery after minimally invasive 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.
• You may experience pain and swelling in the surgical area. Medications will be provided as needed to address these.
• Medications may also be prescribed to address the risk of surgery-related infection and prevention of deep vein thrombosis (DVT) as needed.
• You are advised to keep your 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 surgical area for about 15-20 minutes to reduce postoperative pain and swelling.
• You will be provided with crutches to ambulate safely as soon as you feel comfortable.
• The sutures and cast/splint 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.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• 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, with your doctor’s guidance.
• 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 Minimally Invasive Achilles Repair

Some of the benefits of minimally invasive Achilles repair over traditional open surgery include:

• Minimal muscle trauma
• Minimal scarring
• Allows a solid repair
• Prevents aggressive exposure of the tendon
• Lesser pain
• Faster healing of the tendon
• Minimal risk of infection
• Accelerated rehabilitation program
• Shorter hospital stay
• Quicker recovery
• Allows a more rapid return to full activity

Risks and Complications

Minimally invasive Achilles repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Persistent pain
• Calf weakness
• Nerve damage
• Wound healing problems
• Thromboembolism or blood clots
• Adverse reactions to anesthesia