Percutaneous Repair of the Achilles Tendon

Surgical Technique
To surgically repair the Achilles tendon, we anesthetize the area with a local anesthetic and sedate the patient with intravenous medication.

(Images taken from Bradley et al. Amer J Sports Med 1990 18:2 188)

The proximal portion of the tendon, as identified by palpation and MRI, is captured with a #1 Tevdek suture placed transversely through the skin and the tendon and out the opposite side.

This suture is then crisscrossed through the tendon, the gap at the rupture site, and finally through the distal portion of the tendon just above the calcaneus (heel bone), through the skin punctures.

A second stitch is placed after the first one and is tied with the foot in plantar flexion. 

A dressing is applied and the foot is placed in a plantar flexed pre-formed padded splint.

The Benefits and Risks of percutaneous repair
The benefits of this technique are:

• A full incision is not made, reducing the chance of infection or scar formation.
• The tendon sheath holding the blood clot that forms at the time of the tendon rupture is kept intact, permitting rapid healing of the tendon.
• No general anesthetic is required.
• The rehabilitation program is accelerated.
• Full return to sports is expected (pool at six weeks, golf three months, bicycling three months, tennis six months).

The risks of this technique that have been seen include:

• Transient (temporary) numbness over the lateral border of the foot, if one of the sensory nerves gets caught by one of the sutures. This has always resolved.
• Irritation from one of the suture knots.
• There have been no infections or re-ruptures in our experience since we started using this technique in 1992. We have not opened a single Achilles tendon rupture since 1992.