We present a modification to prior Achilles tendon repair techniques that utilizes readily available noncommercial instrumentation, mini-open incisions, and supine positioning, thus maximizing surgical efficiencies and reducing complications. In our experience, this is a safe and effective technique that minimizes anesthetic requirements and operating room time. Levels of Evidence: Level V, expert opinion

Category: Tendon Introduction/Purpose: Achilles tendon repairs are a common procedure that, historically have been plagued by complications. Recent advanced in both operative and non-operative techniques have changed the landscape for this procedure. Minimally invasive approaches have become far more common which have improved outcomes by decreasing the risk of wound complications. However, a further limiting factor is the traditional need to place the patient prone. This requires higher levels of anesthesia and careful positioning of the extremities. We present a technique that eliminates the need for prone position while maintaining the advantages of a minimally invasive approach. Methods: The authors present a novel surgical technique to repair the Achilles tendon. The patient is maintained in the supine position on the pre-operative stretcher. The leg is externally rotated. A direct medial incision is made at the rupture site and the tendon is repaired by passing suture percutaneously through the eyelets of a bent ring forcep and delivered into the wound. This is performed proximally and distally and then the sutures are tied together to complete the repair. Clinical case time, wound complications and short term outcomes will be reported. Results: 6 patients results will be presented including operative case times which average 57 minutes from the time the patient enters the room until they exit the room and arrive in PACU. This represents a decrease of nearly 30 minutes of OR time required for intubation and prone positioning. 4/6 of the patients received only MAC anesthesia and a nerve block with no tourniquet. The first two patients had general anesthesia with an LMA. 6 month PROMIS and FAAM scores will be obtained but are not available at the time of abstract submission. Conclusion: We present a novel technique to repair an Achilles tendon with the patient in the supine position. The technique is reliable and can be performed with a minimal learning curve. The operative case times are faster as the patient is kept on their recovery stretcher and do not need to be positioned prone. This decreases the amount of anesthesia required for the surgery as well. The authors believe that eliminating prone positioning will be both safer for the patient and results in a faster surgery without compromising outcomes.