Achilles Tendinitis: Bone Spur Removal and Minimally Invasive Achilles Tendon Repair

Achilles Tendinitis: Bone Spur Removal and Minimally Invasive Achilles Tendon Repair

Here is a surgical video on the right foot of a live patient in the operating room of a minimally invasive Achilles tendon repair. This patient was suffering from insertional Achilles tendinitis and underwent surgical treatment. To begin, the surgeon is using x-ray in the operating room and marking out the 4 portals that will be used to perform the procedure.

Here is the Haglund's deformity causing the tendinitis. The surgeon is measuring how much bone needs to be removed. After making the small skin incisions, 2 on top and 2 on the bottom, the surgeon uses a small tool to separate the Achilles tendon from the skin on top of the tendon and from the bone underneath. Using a small burr through the portals, the surgeon will shave down the bone spur. It can be seen on the x-ray that the bone spur is no longer there.

Next, 2 guide pins are placed in the heel bone through the 2 bottom portals. A drill is then placed over the pin and a hole is created to make room for an anchor that will be placed later in the surgery. Since the heel has very hard bone, a tap is used to make threads in the bone. This makes it easier to insert the anchor. The same steps are repeated for the second pin.

Next, the first anchor for the top of the heel, which is made of all suture, is placed in the bone through one of the top portals. A second all suture anchor is then placed through the other top portal. Each anchor has several sutures attached to it. First, these 2 flat sutures that are joined at the end with a needle are passed through the Achilles tendon and through the skin. They will be pulled out from under the skin at a later step. The same thing is done to these 2 flat sutures from the other anchor. The needle is cut off both sets of sutures and they are put off to the side for now.

Next, the rest of the sutures from each anchor are passed through the tendon and up through the skin. They are pulled out from under the skin but are still going through the tendon. They get crossed over each other and linked together, and then tightened down to hold the top edge of the tendon down to bone.