Achilles Tendon Problems - Surgery

Surgery

Achilles tendinopathy

Surgery usually is not necessary to treat Achilles tendinopathy. However, in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath) causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.

Achilles tendon rupture

Surgery is often used to reattach the ends of a ruptured Achilles tendon. It provides a better chance of preventing the tendon from rupturing again compared to using a cast, splint, brace, walking boot, or other device that will keep your lower leg from moving (immobilization).⁵

The results of surgery for an Achilles tendon rupture are best when you have the surgery soon after your injury. Recovering from surgery may take months, and it requires a rehabilitation program to help heal and strengthen the tendon.

Surgery Choices

Surgery for an Achilles tendon rupture can be open or percutaneous.

• In open surgery, the surgeon makes a single large incision in the back of the leg, and stitches the torn tendon back together.
• In percutaneous surgery, the surgeon makes several small incisions rather than one large incision, and stitches the torn tendon back together.

What To Think About

The differences in age and activity levels of participants can make it difficult to determine if Achilles tendon surgery is effective. The success of your surgery can depend on your surgeon's experience, the type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is performed, how soon your rehabilitation program starts after surgery, and how well you follow your rehabilitation program.

In general:

• Both open and percutaneous surgeries are successful. The differences between the two lie in the potential for having another rupture and wound complications.
• Although percutaneous surgery used to have a higher rate of repeat tendon ruptures than did open surgery, recent studies indicate that how often the tendon reruptures is similar—up to 2% for open surgery and about 3% to 7% for percutaneous surgery, depending on how soon you start using the tendon again (mobilization).⁵
• Open repair is more likely to result in wound healing problems than percutaneous repair is. However, damage to a nerve is more likely with percutaneous surgery. Newer techniques for percutaneous surgery may make nerve damage less likely than when older techniques are used.

Your decision about whether to have surgery or use a cast or similar device to immobilize your leg may depend in part on your:

• Attitude toward reinjury and complications. Immobilizing your leg is more likely than surgery to result in another rupture but is less likely to result in complications, such as wound infection.⁵
• Level of activity. If you are very active in sports or have a job that requires leg strength and you want your leg to be as strong as it was before your injury, you may consider surgery.
• Age. If you are an older adult who does not participate in activities that may result in another rupture, and who does not want the added risk of surgery, you may prefer using a cast or similar device.
• Medical condition. If you have another medical condition—such as diabetes or heart or lung disease—that raises the risks associated with surgery,a cast or similar device may be a better treatment for you.
• Time of injury. Surgery is generally recommended if the rupture is more than 2 weeks old.

Talk to your surgeon about his or her surgical experience and success rate with the technique that would best treat your condition.

Should I have surgery for a ruptured Achilles tendon?