Surgery for an Achilles tendon rupture

Surgery Overview

There are two types of surgery to repair a ruptured Achilles tendon :

• In open surgery, the surgeon makes a single large incision in the back of the leg.
• In percutaneous surgery, the surgeon makes several small incisions rather than one large incision.

In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture to let the swelling go down.

What To Expect After Surgery

After both types of surgery, you usually wear a cast, walking boot, or similar device for 6 to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down). Many health professionals recommend starting movement and weight-bearing exercises early, before the cast or boot comes off.

Why It Is Done

This surgery is done to repair an Achilles tendon that has been torn into two pieces.

How Well It Works

In general:

• Both open and percutaneous surgeries are successful. The differences between the two lie in rerupture rates and wound complications.
• Although percutaneous surgery has traditionally been viewed as having higher rerupture rates than open surgery, studies now indicate that the rerupture rates are similar. They are up to 3% for open and about 3% to 7% for percutaneous, depending on how soon you start using the Achilles tendon (mobilization).¹
• Open surgery is more likely than percutaneous surgery to result in wound healing problems. However, damage to a nerve is more likely with percutaneous surgery. Newer techniques for percutaneous surgery may make nerve damage less likely than when older techniques are used.

It is sometimes difficult to determine how surgeries compare, because of differences in the age and activity of those having the surgery. The success of your surgery can depend on your surgeon's experience, the type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is performed, and how soon your rehabilitation program starts after surgery and how well you follow it.

Talk to your surgeon about his or her surgical experience and success rate with the technique that would best treat your condition.

Risks

The risks of Achilles tendon surgery include:

• Skin infection at the incision site.
• Normal complications of surgery or anesthesia, such as bleeding and side effects from medications.
• Nerve damage.
• Risk of repeat Achilles rupture. This risk, however, is typically less than the risk after nonsurgical treatment.
• The possibility that the healed tendon will not be as strong as before the injury.
• Decreased range of motion.

What To Think About

An Achilles tendon rupture is usually treated with surgery or with a cast, splint, brace, or other device that will keep your lower leg from moving (immobilization). When compared with immobilization, surgery provides less chance that the tendon will rupture again and offers a shorter recovery period. However, there is greater risk for wound complications in surgery.

Should I have surgery for a ruptured Achilles tendon?

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Shannon Erstad, MBA/MPH	Last Updated: January 27, 2009
Medical Review:	William M. Green, MD - Emergency Medicine Patrick J. McMahon, MD - Orthopedics
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