Achilles tendon repair at the Stone Clinic is often performed percutaneously following a torn achilles tendon injury. This method has proven to be as effective as an open surgical technique while reducing recovery time.

1. Achilles Tendon: Open versus Percutaneous Repair Kevin R. Stone, M.D.

2. ACHILLES RUPTURES PERCUTANEOUS REPAIR OPEN REPAIR OPEN RECONSTRUCTION WITH ALLOGRAFT

5. Achilles Percutaneous Repair Surgical Technique The proximal portion of the tendon, as identified by palpation and MRI, is captured with a #1 Tevdek suture placed transversely through the skin and the tendon and out the opposite side. Bradley et al. Amer J Sports Med 1990 18:2 188

6. Achilles Percutaneous Repair This suture is then crisscrossed through the tendon, the gap at the rupture site, and finally through the distal portion of the tendon just above the calcaneus, through the skin punctures.

7. Achilles Percutaneous Repair A second stitch is placed after the first one and is tied with the foot in plantar flexion. A dressing is applied and the foot is placed in a plantar flexed pre-formed padded splint.

8. Percutaneous Achilles Repair

11. Achilles Open Repair Beskin et al. Amer J Sports Med 1987 15:1 1

12. Open Reconstruction with Allograft For 14 month old Chronic Rupture MM 05-08-2002

15. PK: Pre-Op R Achilles Tear

16. PK: 2-Months Post-op Percutaneous vs Open

17. PK: L (Open) R (Percutaneous) 8 Months post-op percutaneous 15 Months post-op open

18. PK: R (Percutaneous) MRI 8 Mo. Post-Op Increased tendon diameter 7mm to 15mm. Healed defect in proximal Achilles.

20. RB: Operative Photos

21. RB: 1 week PostOp

22. Rehabilitation: General Considerations • Progression is based on clinical presentation • Careful monitoring of soft tissue quality • Timing considerations

23. Post-operative Protection night splint ROM walker boot

24. Rehabilitation: Early Progression • 0-3 wks: Non-weight bearing , night splint • 3-8 wks: gradual progression into Walker boots with full weight bearing after 6 wks • 8-12 wks: Cowboy boots with gradual wean into regular shoes using heels lifts

25. Manual Treatment Early soft tissue mobilization (edema control) Mid-soft tissue mobilization

26. Post-operative Rehabilitation well leg biking feet on ball bridges

27. Early Rehabilitation prone on ball abduction

28. Ankle PNF Mid Rehabilitation

29. single leg squat single leg resistance Mid Rehabilitation

30. resisted gait proprioception challenge Late Rehabilitation

31. lateral leaps diagonal leap Plyometrics

34. Thank You