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Achilles Tendon Rupture and Repair
MEDICAL ANIMATION TRANSCRIPT: If a person tears their Achilles tendon, the doctor may recommend a surgical procedure to repair the tendon. The Achilles tendon is a thick band of tissue that connects the two muscles in the back of the lower leg, the soleus, and gastrocnemius, to the bone in the heel of the foot called the calcaneus. It is the largest and strongest tendon in the body. It allows the foot to point downward. This movement is necessary to push off the ground to walk, jump, run, or stand on the toes. The Achilles tendon is one of the most commonly injured tendons in the body. Sudden, forceful up or down foot movements can tear or rupture the tendon. This is a common injury among adults who play sports involving running, jumping, and sudden changes of direction, like basketball, soccer, and tennis. Other risk factors for an Achilles tendon tear are aging, taking certain antibiotics, steroid injections into the tendon, being male, increased BMI, smoking, peripheral vascular disease, and diabetes. An Achilles tendon rupture can be partial or complete. A partial tear means the tendon is still connected. A complete tear means the tendon is torn in two. Surgical procedures to reconnect the two ends of the Achilles tendon can be done in one of three ways, open, mini-open, or percutaneous. During an open repair, the surgeon will make an incision down the back of the lower leg. The skin will be opened so the surgeon can see the torn tendon. The surgeon will sew the two ends together with stitches. Occasionally, some tissue will be used from the gastrocnemius. This tissue will be folded over and stitched on top of the tendon to make it stronger. Sometimes a graphed tissue from a donor is used instead. The incision will be closed with sutures or staples. During a mini-open procedure, a smaller incision will be made over the torn Achilles tendon. The skin will be opened to expose the torn tendon ends. A special tool will be inserted into the area. This tool has several small holes in it to show the surgeon precisely where to place the stitches. The stitches will pass through each hole into the skin and through the tendon. The tool will be removed, which pulls the suture under the skin so only the tendon remains attached to the suture. Then it will be turned upside down and the steps will be repeated. The surgeon will tie the stitches on the top and bottom of each side together, reconnecting the tendon. The incision will be closed with sutures or staples. During a percutaneous repair, the surgeon will make smaller surgical cuts. Three to six cuts may be made, but it depends on the surgeon. The stitches will pass through each hole and each end of the torn tendon. The stitches will be pulled together, reconnecting the tendon. The incisions will be closed with stitches.
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