Surgery for an Achilles Tendon Rupture

Surgery Overview

There are two types of surgery to repair a ruptured Achilles tendon:

• In open surgery, the surgeon makes a single large incision in the back of the leg.
• In percutaneous surgery, the surgeon makes several small incisions rather than one large one.

In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture. This delay lets the swelling go down.

What To Expect

After either open or percutaneous surgery, you will likely wear a cast, walking boot, or similar device for 6 to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down). Many health professionals recommend starting movement and weight-bearing exercises early, before the cast or boot comes off. Your total recovery time will probably be as long as 6 months.

Why It Is Done

This surgery is done to repair an Achilles tendon that has been torn into two pieces.

How Well It Works

Both open and percutaneous surgeries are successful. More than 80 out of 100 people who have surgery for an Achilles tendon rupture are able to return to all the activities they did before the injury, including returning to sports.^{footnote 1}

It's sometimes hard to know how surgeries compare. That's because the ages and activities of people having the surgeries differ. The success of your surgery can depend on:

• Your surgeon's experience.
• The type of surgery you have.
• How bad the tendon damage is.
• How soon after rupture the surgery is done.
• How soon your rehabilitation program starts after surgery.
• How well you follow your rehab program.

Talk to your surgeon about their surgical experience and success rate with the technique that would best treat your condition.

Risks

The risks of Achilles tendon surgery include:

• Skin infection at the incision site.
• Normal complications of surgery or anesthesia, such as bleeding and side effects from medicines.
• Nerve damage.
• Risk of repeat Achilles rupture. This risk, though, is typically less than the risk after nonsurgical treatment.
• The possibility that the healed tendon will not be as strong as before the injury.
• Decreased range of motion.

Infection is possible with any surgery, but it may be more common with open surgery than with percutaneous surgery. The small risk of other complications is about the same with either open or percutaneous surgery. And most problems go away over time. These complications include pain, delayed wound healing, nerve damage, and problems with scarring.