Achilles Tendon Repair

WHAT YOU SHOULD KNOW:

• Achilles (ah-KIL-ez) tendon (TEN-don) repair is surgery to fix your damaged Achilles tendon. Tendons connect muscles to bones, and together with muscles, work to move your arms, legs, fingers, feet, and toes. The Achilles tendon is located at the ankle, and connects the calf muscle to heel bone. Achilles tendon repair is done to reattach a ruptured (completely torn) Achilles tendon. This may be done using an open or a mini-open surgery. In a mini-open surgery, a special device is used without making a large incision (cut) in the ankle area. A complete tendon rupture may be acute or chronic based on the duration of time from injury. Injuries that occurred within three weeks are considered as acute, and after three weeks they are chronic. Chronic injuries can only be repaired using the open surgery.
  
  
• During surgery, caregivers repair the injured Achilles tendon by sewing the ruptured ends together. A tendon or fascia (hard tissue) graft may be used to strengthen the repair. The graft may be man-made, taken from another part of your body, or from a donor. It is used mostly in chronic tendon injuries. After surgery you may need a splint or cast to protect the tendon and help it heal. You may need to do special exercises to help build the strength back in your ankles. With repair of the Achilles tendon, your regular ankle and foot movements may be returned, and normal activities restored.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You could get an infection or bleed too much. You could have trouble breathing or get blood clots. Other parts around the tendon, such as blood vessels and nerves may also be affected. Sometimes, even after surgery, the ankle may not go back to the way it was before. If you do not have surgery, the pain and problems you have when moving your ankle or foot may worsen. You may have problems walking, and may have trouble going back to your usual activities, including sports. Call your caregiver if you are worried or have questions about your injury, treatment, or care.

WHILE YOU ARE HERE:

Before surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Anesthesia: This is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep.

During surgery:

• You will be placed on your stomach with your feet hanging at the end of the table. A rubber cuff called a tourniquet is put around your leg. This slows down the blood flow to the ankle and helps decrease blood loss. Your caregiver cleans your leg, ankle, and foot with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• For open surgery, caregivers make a long incision on your ankle. The joint is checked and the torn ends are identified. Blood clots are washed off and torn edges of the tendon are cut out. Caregivers sew the ends of the torn tendon back together. A graft may be placed to strengthen the repair. Caregivers may also cut a strip of the calf fascia, twist, and turn it down over the repair. The incisions are closed with stitches and wrapped with a bandage.
  
  
• For a mini-open surgery, caregivers feel your ankle to look for the gap made by the missing tendon. A small incision is made in this area. A device shaped like a letter 'w' is inserted into the incision. This device is adjusted to fit the tendon properly and hold the tendon ends. Once in place, stitches (threads) are passed through the sides and left inside. The stitches are passed in three areas, with extra thread left on both ends of the torn tendon. The stitches are then tied in pairs, and the incisions are closed with stitches and wrapped with a bandage. With both surgeries, a cast or splint is put on your ankle so it can heal faster.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. If you had general anesthetic, an adult will need to drive you home. Your driver or someone else should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
  
  
• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Achilles Tendon Repair (Inpatient Care)