Abstract
Operative repair of tendo Achilles ruptures is associated with a lower re-rupture rate. A medial approach is made and the tendon ends debrided. The tendon is repaired with two non-absorbable core sutures and an absorbable perimeter suture, with care to avoid any lengthening of the musculotendinous unit. The tendon sheath is repaired, with a deep fascial releasing incision to allow apposition of the edges if necessary. In the case of insertional avulsions, the avulsed bony fragment is excised and the tendon repaired to bone with a 3.5 mm corkscrew anchor and non-absorbable suture.
A frontslab is applied with the ankle in gravitational equinus and worn for eight weeks with protected weight bearing. Sutures are removed at 10 to 14 days and active range of motion commenced. At eight weeks, weight bearing as tolerated is allowed with a heel raise and physiotherapy for calf strenghthening is commenced. Recovery of full strength will take one year.
