Achilles Tendon Repair

Sterile Instruments/Equipment

• Tourniquet

• Number 2 FiberWire suture (Arthrex, Inc., Naples, FL)

• 3-0 Prolene suture (Ethicon, Inc., Somerville, NJ)

• 3-0 Vicryl suture (Ethicon, Inc., Somerville, NJ)

• 4-0 Vicryl suture (Ethicon, Inc., Somerville, NJ)

• 4-0 Ethilon suture (Ethicon, Inc., Somerville, NJ)

Positioning

• The patient is positioned prone.

• All bony prominences are carefully padded.

• Both legs are prepared and draped (Fig. 63-1).

• The nonoperative leg will be used to set the tension of the repair.

Figure 63-1 | Patient positioning for an Achilles tendon repair. Both legs are prepared so that resting tension of the nonoperative side can be assessed during surgery.

Surgical Approach

• A longitudinal incision is made over the medial border of the tendon (Fig. 63-2).

• This avoids the sural nerve and allows access to the plantaris tendon if needed.

Figure 63-2 | Longitudinal incision over the medial border of the Achilles tendon (left leg). (Borrowed from Chapter 110 of Operative Techniques in Foot and Ankle Surgery [Technique Figure 1]).

• The skin and subcutaneous layer are mobilized laterally.

• The paratenon is preserved.

• The sural nerve and lesser saphenous vein are protected as they course lateral to the paratenon.

• A midline incision is made through the paratenon, away from the skin incision.

• The fascia is released just anterior to the Achilles tendon (Fig. 63-3) to allow a less tensioned wound closure.