Limited Open Achilles Repair Without Instrument-Guided Assistance

Abstract

Background: The limited open Achilles tendon repair technique has recently gained popularity as a treatment option for acute Achilles tendon ruptures. This surgical technique video describes a limited open Achilles tendon repair without instrument guided assistance, demonstrating improved clinical outcomes for patients while also reducing reliance on operative equipment, cost, and the duration of surgery. Indications: The indications for this limited open Achilles tendon repair technique include an Achilles tendon rupture less than 6 weeks from injury occurring in the watershed area. Technique Description: The patient is prone and a 2- to 3-centimeter longitudinal incision is made over the Achilles tear. In the proximal stump, 3 nonabsorbable sutures are passed horizontally from proximal to distal direction. In the distal stump, the same is done in a nonlocking manner. The stumps are then reflected and the deep fascial compartment is released. The foot is plantarflexed to reduce tension on the repair site. The nonlocking sutures are tied sequentially from distal-distal to proximal-proximal direction. A running box suture using a nonabsorbable suture followed by 0-Vicryl around the rupture site is performed. Results: This technique has demonstrated, at a median follow-up of 3.7 years, restored pre-injury function along with no wound complications, re-ruptures, or re-operations in 33 patients. The median time from injury to surgery was 10 (range, 1-45) days and the mean time for returning to pre-injury level of activity was 5.6 (range, 1.7-22.1) months. After the procedure, patients demonstrated significant improvements in mean Foot and Ankle Disability Index (49.1-98.4), mean Visual Analog Scale pain score (4.8-0.2), and mean Foot and Ankle Outcome Score (FAOS) subscales such as FAOS pain (54.8-99.2), FAOS symptoms (84.6-97.0), FAOS activities of daily living (61.4-97.2), FAOS sports and recreational activity (39.5-98.5), and FAOS quality of life (39.7-88.7). Conclusion: Patients who underwent a limited open Achilles tendon repair without instrument-guided assistance demonstrated significant improvements in outcome scores with minimal complications.