surgical treatment of Achilles tendon ruptures

Surgical treatment of Achilles tendon ruptures has been the main stay of treatment for many years. Years ago the tendon was approached through a long posterior incision, repair was made with large sutures and a long leg cast applied. More recently smaller incisions have been used with careful preservation of the skin, limited retraction of the skin and a careful repair of the peritenon, and a short leg cast used. The biggest risk of these surgeries has been infection, likely because of the poor vascular supply of the area.
As result of these complications, which can be devastating, less invasive techniques using minimal incisions and percutaneous suturing have been developed. In the absence of complications such as infection, the results of both types of techniques have been very gratifying. Postoperatively the patient is placed in a rigid cast for 2-3 weeks nonweightbearing. Partial weightbearing with a plantar flexion cast or brace and active dorsiflexion with passive plantarflexion is started. The full time for rehabilitation can be 3-6 months for a normal person but return to sports can take as long as one year. As always, diabetes and smoking increase the risk of complications and failure.
Neglected Achilles tendon tears, those over a few weeks or recurrent tears can require more complex surgery such as tenon turn downs, allografts or flexor hallusis transfers, more about the last later.
Overall the surgical results are excellent with a low rerupture rate, but an increased infection and complication rate which has to be recognized before surgery is undertaken.

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