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Achilean Tendon Suturing Techniques

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

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For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of the Centrokinetic Clinic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

 


Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

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The Achilles tendon is a strong, fibrous tendon through which the gastrocnemius and soleus muscles are inserted on the heel. When contracted, these muscles pull on the Achilles tendon, helping you to rise on your toes, practically extending your ankle and foot. This strong group of muscles will help you when you sprint, jump or climb stairs, practically propelling the body forward. Several different problems can occur in the Achilles tendon, the most serious being the rupture of the Achilles tendon.

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The treatment is quite controversial, many authors comparing the results obtained with orthopedic treatment with the surgical one. Interestingly, the results obtained with orthopedic treatment are similar to those obtained with surgical treatment, in the case of an incomplete rupture. In the case of surgical treatment, the recurrence rate is much lower. However, surgery is recommended as the main method of treatment.


Surgical techniques

There are several surgical techniques used, of which we choose to briefly describe a few. The anesthesia used is spinal (spinal anesthesia).

  • Krackow technique (incision 10 cm long, 1 cm medial to the tendon, up to the edge of the shoe). The 2 fragments of the Achilles tendon are confronted, passing 2-0 non absorbable sutures, both through the proximal and the distal fragment.

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  • Lindholm technique (a method used for ruptures younger than 10 days). The two ends are sutured directly, and over this suture take off from the proximal fragment 2 strips 1 cm wide and about 7-8 cm long which are passed over the initial suture and attached along their entire length to the distal fragment.

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  • Lynn technique: the plantar tendon is reinserted over the sutured Achilles tendon

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  • Teuffer technique: the tendon of the short peroneal muscle is dissected from the metatarsus V, then is passed through a hole made in the calcaneal tuberosity and sutured in the proximal portion, thus strengthening the Achilles tendon near its insertion.

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  • Modified Teuffer technique: the tendon graft of the short peroneal muscle is sutured medially and laterally. This technique is used for higher ruptures of the Achilles tendon.
  • Ma and Griffith: percutaneous repair of Achilles tendon ruptures.

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  • White and Kraynick technique (also a modified Teuffer): suturing the short peroneal muscle tendon on the Achilles tendon through a hole made in the tuberosity of the calcaneus. Strips of the plantar tendon are used to strengthen ruptures of the Achilles tendon.
  • Bosworth technique. A tendon strip about 1.5 cm wide and 17-22 cm long is cut from the gastrocnemius muscle, this strip is kept distally attached. The band is used to face the 2 fragments and for suturing.

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If the suture, reconstruction, or stabilization is not possible, the transference of the tendon of the long flexor of the hallux can be made.


Postoperatively

After the intervention, the patient remains hospitalized for 1 day. He will receive pain medication and antibiotics during hospitalization. The operated limb is immobilized in a plaster splint, and the patient is advised not to make ankle movements, 14 days. Free walking is not allowed immediately. You need to use crutches, even if the chosen intervention was minimally invasive.

 Patients will wear a compressive bandage on the foot for 5 days. Patients can return to family and professional activities quickly, up to 3-4 weeks, if they have office work, and 10-12 weeks, if they have fieldwork.

At home

Although recovery after this operation is much faster than a classic intervention, it will still take a few weeks for you to fully recover the operated joint. You should expect pain and discomfort for at least a week postoperatively. You can use a special ice pack, which will reduce the pain and inflammation. You must be careful not to lean on the operated area in the first weeks because the pain and discomfort can worsen. You can take a bath, but without wetting the bandage and incisions. The threads are suppressed at 14 days postoperatively.

At 3 months postoperatively, an MRI is necessary to see how the tendon suture heals. Driving is allowed after 6-8 weeks and hard physical work after 10 weeks.

Physical therapy plays a very important role in the rehabilitation program, and the exercises must be followed by a physical therapist until the end of the recovery period.

It is very important to follow the recovery program strictly and seriously for the surgery to be a success. Our medical team works on average with the patient after this intervention, 12-16 weeks until complete recovery of the operated area.

Following any surgery, medical recovery plays an essential role in the social, professional, and family reintegration of the patient. Because we pursue the optimal outcome for each patient entering the clinic, recovery medicine from Centrokinetic is based on a team of experienced physicians and physical therapists and standardized medical protocols.