Minimally invasive Achilles tendon surgery

Rehabilitation Reimbursement / Medical Leave Pathology / Pain Post-operative recovery

Percutaneous Achilles Tendon Operation: Definition

Before we see what percutaneous Achilles tendon surgery is, let’s look at the different types of lesions.

The Achilles tendon connects the muscles of the calf to the bone of the heel, the calcaneus. This tendon is constantly used in various activities. It is thanks to this tendon that it is possible to walk and get on the tips of your toes. When you get on your toes, your calf muscles contract and get shorter. The Achilles tendon will lift the heel off the ground by pulling upwards.

Repeated strains of the Achilles tendon can lead to different conditions. The most common is Achilles tendonitis, a common inflammation in athletes and people who are overweight. Over time, this condition can worsen and lead to a weakening of the tendon filaments, which can break abruptly during effort.

Failure of the Achilles tendon may cause walking problems, pain and decreased strength.

The various lesions: tendonitis and rupture

There are several types of Achilles tendon.

Tendonitis of the Achilles tendon among which we know peritendinitis (inflammation of the sheath located around the tendon), corporeal tendinitis is an inflammation of the tendon in the body and insertion tendinitis is the inflammation of the tendon insertion area on the calcaneus (insertion tendinitis or haglund syndrome).
Achilles tendon ruptures: fresh and old lesions. Fresh lesions are recent ruptures that differ from untreated and unsupported old ruptures. Among the recent lesions, it is also possible to distinguish the lesions in the full tendon body, the lesions in the myotendinous zone and the calcaneal bone disinserations.

These ruptures require different surgical procedures.

Why perform Achilles tendon surgery in percutaneous suture?

It is essential not to leave this type of pathology lying around and to consult a surgeon specialized in percutaneous Achilles tendon surgery to avoid any risk of aggravation.

In some cases, orthopedic treatment is possible. This treatment consists of a complete immobilization of the foot thanks to a plaster for two and a half months. However, the risk of a new rupture remains high. Surgical treatment is therefore recommended, especially in active or sports patients. Surgery has many benefits for the patient as it reduces the risk of recurrence, reduces period of immobility and provides faster recovery.

Different approaches to percutaneous Achilles tendon surgery in the event of rupture

Julien Lopez takes care to adapt the surgical treatment to the type of lesions. There are several approaches to repair a tendon rupture (percutaneous Achilles tendon surgery, reconstructive surgery, etc.).

Recent tendon body injury

This type of injury is easily repaired with surgery. The procedure performed by the foot surgeon consists in bringing the edges closer to obtain tendon healing. This procedure can be performed in the open (open Achilles tendon suture): the surgeon opens and sutures the tendon end to end.

The other technique is a percutaneous suture of the Achilles tendon through the use of a device called Tenolig. In this case, repair of the Achilles tendon rupture through percutaneous operation is possible. To do this, the surgeon performs percutaneous gestures using small instruments to make four incisions of only a few millimeters.

The Tenolig is a system composed of two wires each connected to a harpoon passing in the muscle then in the rupture zone and in the tendon. It then comes out through the skin. The wires are then tightened to allow the banks to come together. At the end of the operation, the threads are firmly attached to the outside of the leg until healing is complete. Once the healing is done, the Tenolig will be removed and consolidation can continue until complete recovery of ankle mobility.

Recent myotendinous lesion

In the case of a myotendinous lesion, surgery is discussed but rarely performed. It depends on the level of the rupture, the muscle and tendon contingent and the general condition of the patient (smoking, age, comorbidities, treatment, etc.).

Old lesion

In case of an old lesion, reconstructive surgery will be preferred by the surgeon. This type of surgery aims to rebuild part of the tendon in order to fill the loss of substance that may have occurred over time. A tendinous band is thus taken and turned over on itself in order to be firmly sutured with wires on the lower bank.

Different approaches to percutaneous Achilles tendon surgery for tendonitis

Achilles tendinitis in the body of the tendon: corporeal tendinitis

Achilles tendonitis is the most common form of inflammation of the Achilles tendon. The treatment is always medical first-line combining physiotherapy, soles, shock wave, cryotherapy, weight loss, healing etc. In case of failure of well-conducted medical treatment for more than 3 to 6 months, the surgeon will propose a surgical treatment of tendonitis.

Percutaneous or minimally invasive surgical treatment of Achilles tendonitis is possible. The principle is to make 1 incision of 1 to 2 cm maximum then to make axial incisions in the body of the tendon.

The healing of these incisions will create a non-inflammatory «neotendon» which will be able to take over the inflammatory tendon. The procedure takes place in outpatient surgery, under local anaesthesia. Full support is allowed immediately with the wearing of a boot for 21 days. The surgeon often combines an injection of PRP into the cracks at the end of the procedure to increase the chances of success of the procedure.

Note: Corticosteroid injections within the Achilles tendon are strongly discouraged because they can cause a rupture.

Achilles tendinitis located at its insertion on the calcaneal bone: tendinitis of insertion

Insertion tendinitis is also accessible to minimally invasive and percutaneous treatment mainly in cases of Achilles tendonitis secondary to Haglund syndrome. In more rare cases, percutaneous treatment may be offered in calcifying tendinitis of insertion of the Achilles tendon.

The surgical suites of minimally invasive tendon surgery in case of rupture

The tendon suture during minimally invasive surgery of the tendon is performed outpatients and lasts on average 1h. Depending on your health and your history, several anesthesia techniques can be proposed to you: general anesthesia or loco-regional anesthesia.

Once the surgery is complete, a plastic boot is put in place. The purpose of the splint is to immobilize and protect the ankle for the first few weeks after the operation. Ground support is prohibited during this period. To facilitate walking, the patient can use canes prescribed by Dr. Julien Lopez.

In order to effectively relieve pain, Dr. Julien Lopez will implement a painkiller treatment during the first postoperative days.

After this time, the boot can be removed and support will be possible with a heel. The thickness of the heel can be reduced every week for 3 weeks.

In order to regain complete foot mobility, Dr. Julien Lopez will prescribe physiotherapy sessions.

Resuming activity

The resumption of normal activities can take place from the 3rd month.
The recovery of the steering wheel is also possible from the 3rd month.
Sports activities that are not aggressive for the body, such as swimming or cycling, can gradually resume after the 3rd month.
Intense sports and group sports will be possible around the 6th to 8th month.

It is strongly recommended that percutaneous technique be preferred to the open-air Achilles tendon technique. Percutaneous surgery is particularly effective for Achilles tendon lesions. In more than 90% of cases, the resumption of a sporting activity, even of high level, is possible.

The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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