Surgical reattachment of tendons — Achilles, biceps, finger flexor/extensor — torn due to trauma or chronic degeneration.
Indication
- Achilles tendon rupture (acute total rupture) — in athletes and active adults
- Biceps tendon rupture (proximal or distal) — cases with loss of function
- Finger flexor/extensor tendon ruptures — after laceration or trauma
- Tendon tears with delayed treatment or unresponsive to conservative management
- Rotator cuff tears — full-thickness with functional loss
- Patellar / quadriceps tendon ruptures (loss of knee extension)
Preparation
- Clinical examination (Thompson test for Achilles, Hawkins test for biceps) and ultrasound / MRI imaging
- Blood tests, ECG; blood thinners adjusted with physician approval
- In acute injury, surgery is planned within 7-14 days (before tendon shortening increases)
- Fasting for 6-8 hours before the procedure (depending on type of anesthesia)
- Planning of post-surgical cast / brace and immobilization period
How it's performed
- Regional or general anesthesia; bloodless surgical field with tourniquet
- Technique chosen according to tendon structure: Achilles tendon rupture — open (Krackow / Bunnell suture) or percutaneous (minimal skin incision, systems such as Achillon); decision based on tendon quality, rupture site, and skin condition
- In biceps rupture: proximal — tenodesis (fixation to bone) or tenotomy; distal — fixation with interference screw or cortical button
- Tendon ends are debrided; reattached end-to-end or to bone using high-strength sutures (Krackow, Pulvertaft) or double-row suture technique
- Range of motion is tested passively, tension is assessed
- Soft tissue layers are closed; appropriate cast or brace is applied
Post-procedure
- First 2-6 weeks immobilization (in equinus position for Achilles); gradually returned to neutral
- Early controlled passive motion protocols (Kleinert / Duran for finger flexor tendon)
- Physical therapy: active motion and strengthening exercises between 6-12 weeks
- Gradual weight-bearing — partial at 6-8 weeks, full at 12 weeks for Achilles
- Return to sport generally 4-6 months; varies by tendon quality
Risks
- Re-rupture — 2-5% for Achilles (surgical), increased with early loading
- Infection, wound healing problems (especially in open Achilles repair)
- Nerve injury — particularly the sural nerve (Achilles), radial nerve (distal biceps)
- Tendon adhesion, joint stiffness — physical therapy required
- Deep vein thrombosis (DVT) — due to prolonged immobilization
FAQ
What is the difference between open and percutaneous surgery for Achilles rupture?
Open surgery offers the advantage of strong suturing with direct visualization of tendon ends; however, the risk of wound healing problems and infection is somewhat higher. The percutaneous method is performed through a smaller incision with cosmetic advantage; sural nerve injury risk exists. Choice depends on rupture site, skin condition, and surgeon experience.
Can I heal with a cast instead of surgery?
In some Achilles ruptures, conservative treatment (early motion with functional brace) can yield results close to surgery. However, the re-rupture rate is lower with surgery. The decision is based on age, activity level, and rupture type.
When can I return to sport?
Light walking is possible at 6-8 weeks, running at 3-4 months, full sport generally at 4-6 months. This time varies by tendon type and healing rate; gradually increased under physician and physical therapist supervision.
Will my tendon return to its full former strength?
Most patients regain approximately 85-95% function. Full symmetry is not always achieved; especially in Achilles and rotator cuff, a small strength difference may remain. Regular exercise supports recovery.
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