Achilles Tendon Tears: Achilles Tendon Midsubstance Repair

Achilles Tendon Tears: Achilles Tendon Midsubstance Repair

This surgical demonstration will show a minimally invasive Achilles tendon repair on a right ankle. The surgeon will start with a small horizontal incision just above the heel. The surgeon will dissect the soft tissue, careful to avoid any nerve structures until the Achilles tendon tear is found. The tendon is captured with clamps to stabilize the tendon.

Next, the minimally invasive jig is brought into the incision and put in the appropriate position. Once in place, this jig will help with passing sutures through the torn tendon. Needles are placed into the appropriate holes on the jig. The needles have a loop on the end that allows for sutures to be threaded through. The needles and sutures are then passed at different locations in the jig to form the appropriate configuration, which strengthens the repair construct. Once all the sutures are passed through the tendon, the minimally invasive jig is removed.

The sutures are then passed through each other in a specific order. This helps create a strong construct in a minimally invasive fashion where, in the past, these steps were done through a large, wide-open incision. Next, the bottom end of the Achilles tendon tear is identified and is clamped to gain control. You will see a small incision is made over the heel bone where some of the sutures will be anchored. Drill guides and drills are used to create pilot holes where the anchors will end up on the heel bone. A wire is placed in the prepared drill hole so the surgeon can easily find the spot again when they are ready to place the final anchor. This process is then repeated for a second location.

After the sockets are prepared, a suture-passing device is used to pass the sutures through the bottom portion of the Achilles tendon, allowing the two torn ends to be brought together. This technique assures for a knotless construct, whereas previously, surgeons would simply tie two ends of the torn tendon together. The sutures are passed into the anchors, and with appropriate tension and positioning of the foot, the anchors are placed into the prepared bone holes to secure the repair. This results in a secure, knotless, minimally invasive repair of the Achilles tendon.