Three main techniques are used to repair ruptured Achilles tendons.
This technique consists of passing two sutures with preloaded needles into which small harpoons are embedded. The entry points are about 6 cm proximal to the tear on the posterolateral side of the tendon. The exit points are on the posterolateral side of the tendon over the retromalleolar space, 4 to 5 cm below the tear.
The surgeon passes the two needles percutaneously proximal to distal, through the ruptured tendon.
The harpoons attach themselves into the upper portion of the tendon. The sutures are pulled downwards to bring the two ruptured tendon ends together, and then locked with polyethylene discs against the skin. The sutures can be removed by the surgeon after about 6 weeks.
The percutaneous technique is based on four principles.
- Bringing the two ruptured Achilles tendon ends together for 6 weeks without using a surgical incision. During this time, the entire tendon can be mobilised through flexion/extension movements of the foot.
- Not devascularising the tendon by unnecessarily opening its sheath.
- Preserving the post-rupture haematoma to ensure good, fast healing.
- Allowing early mobilisation to guide the alignment of collagen fibres and hasten their transformation into efficient elastic tendon fibres.
Successful Tenolig use requires that the surgical technique be followed and that the patient complies fully with the postoperative protocol.
This technique consists of using two consecutive knee-to-ankle casts:
the first with the ankle in full plantarflexion so that the two tendon ends are as close together as possible, and the second with the ankle at 90°.
In this technique, the two tendon ends are sutured together through a 10 to 15 cm skin incision.