Surgery for Achilles Tendinopathy

Fixing the Famous Tendon

Apr 9, 2009 Naheed Ali

There are various treatment options available for Achilles tendinopathy, and surgery is one of them.

Surgical operation generally isn't necessary for dealing with Achilles tendinopathy. However, in certain instances, a patient might try surgical operation when the rubbing between the tissue covering the tendon (tendon sheath) and the tendon makes the sheath become enlarged and fibrous. Operation can be performed to take away the fibrous tissue and fix any minor tendon tears. This can also help protect against future Achilles tendon ruptures.

Achilles Tendinopathy and Tendon Rupture

Surgery is sometimes performed to reattach the edges of a snapped Achilles tendon. This gives a better chance of keeping the tendon from snapping again, as compared to applying a splint, brace, walking cast, or other immobilizer. This will keep the lower leg from rolling (immobilization).

The outcomes of surgical operation for an Achilles tendon rupture are most helpful when you have the surgery shortly after your traumatic injury. Recovering from the procedure could take months, and it calls for a rehabilitation regimen to assist in the healing and functioning of the Achilles tendon.

Surgical operation for an Achilles tendon rupture may be either "percutaneous," or “open.” In open Achilles tendon surgery, the doctor creates a single large incision behind the leg, and sews together the ruptured tendon.

In percutaneous Achilles tendon surgery, the doctor makes a few small incisions, as opposed to one large incision, and sews together the ruptured tendon.

Surgery and Achilles Tendinopathy

Differences in age and physical activity levels of individuals can make it challenging to decide if Achilles tendon surgery is effective. The quality of the procedure can depend on the doctor's experience level, the kind of surgery used, the severity of tendon damage, how soon the surgery is executed after the injury, how soon the rehabilitation program commences after operation, and how accurately a patient follows his rehab requirements.

Both open and percutaneous operations are successful. The differences between the two lie in the possibility of having other injuries and bruise complications.

While percutaneous surgery previously had a higher rate of recurrence of injury than did open surgery, recent reports suggest that how often the Achilles tendon re-ruptures is very similar—up to 2% for open surgery and approximately 3% to 7% for percutaneous operation. This is contingent on how soon the patient begins using the tendon again.

Open surgery is a lot more likely to result in wound healing issues than percutaneous surgery is. Still, injury to a critical nerve is more likely with percutaneous repair. Modern techniques for percutaneous operation may make nerve impairment less likely than when older methods are applied.

A decision on whether to have a surgical operation or to wear a cast or similar immobilizer to "lock" the leg could depend on numerous factors, such as attitudes toward complications and the potential re-occurrence of injury. Immobilizing the leg with a device is more likely than surgery to result in another tear but is less likely to have complications like wound infection.

The amount of physical activity a person has in his daily life can also impact the decision to perform surgery. If you're very active in outdoor games or have an occupation that requires leg endurance and you prefer your leg to be as agile as it was prior to your rupture, you may consider surgical procedures.

If you are an older patient who hardly ever takes part in sports that may result in additional injury, and if you do not like the added risk of having an operation, you may choose to use a cast or similar device.

If you suffer from another medical illness—like diabetes or heart or lung disorder—that heightens the risks related to surgery, a cast or similar immobilizer could be a better fix for you. Lastly, surgery is most often recommended when the injury is more than two weeks old.