30 Achilles Tendon Repair

10.1055/b-0040-174153

30 Achilles Tendon Repair

C. Lucas Myerson, Jimmy J. Chan, and Ettore Vulcano

Summary

The Achilles tendon, the largest and strongest tendon in the body, is a consolidation of the gastrocnemius and soleus muscles. Rupture occurs most commonly in the tendon mid-portion, in a poorly vascularized region approximately 3–6 cm above the tendon insertion site on the posterosuperior aspect of the calcaneal tuberosity. Tendon rupture occurs predominantly in men in the third to fifth decades of life, and direct trauma is rarely reported. Indirect rupture is seen as a consequence of intratendinous degeneration and rapid loading sequence on an already tense Achilles. ¹ Operative repair, followed by early mobilization, is the preferred treatment for patients with an active lifestyle. Multiple operative approaches to Achilles tendon repair have been described. The choice of repair technique depends on the size of the defect, the length of time that has passed since the injury, and cosmetic concerns.

30.1 Preop

Plain radiographs are acquired to identify any fractures, avulsions, or tendinopathy. ²
- Ultrasound and MRI may be helpful in determining the level of rupture and the size of the defect, but are not typically necessary for diagnosis.
- Lateral radiograph may reveal disruption of Kager’s triangle, the triangular fat pad anterior to the Achilles. ³
Surgical table. Standard operating table with Wilson frame and foam head rest
Patient position. Prone, with an upper thigh tourniquet on the operative leg for hemostasis
Extremity position. Hang legs over the edge of the bed, place a pillow or towels under both ankles, and drape both legs into operative field.