Orthopaedic Surgery - Surgical Repair of Achilles Tendon

Procedure

A tendon is a band of tissue that runs from a muscle to bone. The Achilles tendon runs from the calf to the heel bone. When your calf muscle contracts (flexes) the tendon pulls the foot down and lets you go on tiptoes.

Your Achilles’ tendon has torn. You may have come to joint decision with your surgeon to repair it surgically. This means stitching the two ends of torn tendon back together again.

The surgeon will see you before the operation. The surgeon will mark with a felt pen on your injured leg. This is to make sure the correct limb is operated on in theatre. You will have an anaesthetic in theatre.

This may be a general (when you are asleep). While you are asleep in operating theatre, a tight inflatable band may be wrapped around the thigh. This is a tourniquet and is to limit the amount of bleeding.

The surgeon will make a cut with a surgical knife (an incision) down the back of the ankle. This may be one straight incision down the ankle or 3 separate small horizontal incisions. The surgeon will then stitch together the two ends of the tendon with a special, strong material.

When happy, the surgeon will close the wound with stitches. These may be under the skin (dissolvable) or above the skin (non- dissolvable). If the latter are used, the stitches will need to be removed in around 10-14 days - your surgeon will inform you.
 
When you wake up from theatre, you will have a cast on your leg. This is to keep the ankle still (immobilise it) while the tendon heals.

You can leave the hospital when you feel well enough and have been taught how to walk with crutches. Unfortunately, you will not be able to drive home.

Please be aware that a surgeon other than the consultant, but with adequate training or supervision may perform the operation.

Alternative procedure

Researchers disagree whether to operate on torn Achilles’ tendons. Some research shows that treating conservatively (not operating) has an equal “success” rate to surgery but also has far fewer complications.

Other surgeons say that surgery is especially successful if you are very active or sporty. Please be aware that you could be in a plaster cast for a similar amount of time whether operated or not.

With either treatment, you will wear a cast for a similar amount of time.

Risks

As with all procedures this carries some risks and complications.

Common (1-5%)

Pain

The procedure does involve moving soft tissue and will hurt afterwards. It is important to discuss this with the staff and ask for pain killers if needed. You are advised to keep your limb up as much as possible (before and after the operation). This will keep the swelling and pain to a minimum.

Bleeding

There will inevitably be some bleeding. But is not usually excessive.

Scar

The operation will leave a thin scar where the cut is made. This can be very irritating.

Infection

This may present as redness, discharge, or temperature around the wound. A course of antibiotics may be necessary. The wound can break down in these cases. In some cases, the wound breaks down for no obvious reason.

Stiffness

This may be temporary, and physiotherapy will help to lessen the restriction.

Re-rupture

The repair may tear again. This cannot be predicted but moving it too early is often a cause.

Rare (<1%)

Thick/keloid scar

These are scars which grow excessively (within the wound margin. They occur in some people and cannot be predicted although if you have a previous keloid scar you are at greater risk. Scars may be treated with steroid injection or surgically if necessary.

Delayed wound healing

May occur if the wound is under tension, infected or short of blood supply. The scar will look worse in this case.

Fat necrosis

This is also a cause of delayed wound healing. Again, the scar will look worse.

Neurovascular damage

There are numerous blood vessels and nerves around the ankle. These may be damaged during the operation. In most cases, they can also be repaired. Rarely, damage may result in numbness or weakness of muscles. This is usually temporary but rarely permanent. There can rarely be damage to a tendon.

DVT

This is a deep vein thrombosis. A blood clot in the blood vessels They can be painful and if they travel to the lungs they can seriously affect your breathing.