What is Involved in Achilles Tendon Reconstruction?

H. Colledge

The Achilles tendon is a thick band of tissue that joins the calf muscle to the bone of the heel. Achilles tendon reconstruction is a type of surgery carried out to treat an Achilles tendon rupture, where the tendon has completely snapped in two after being overstretched. Sometimes Achilles tendon repair involves simply sewing the two severed pieces of tendon together, but, if parts of the tendon have deteriorated, they may have to be removed and replaced by tissue grafts.

A diagram of the Achilles tendon and common tendon problems.
A diagram of the Achilles tendon and common tendon problems.

An Achilles tendon snap is more likely to occur in middle age. Men are more frequently affected, typically while taking part in athletic activities, such as basketball, which involve running, jumping and turning. Some people report that a rupture of the Achilles tendon feels like being shot. A feeling of snapping or popping may be experienced, together with a sharp pain in the back of the calf muscle or ankle. The tendon usually breaks at a point around 2 inches (about 5 cm) above its attachment to the heel bone, and sometimes a gap may be felt at this point.

Achilles tendon reconstruction may be carried out using open surgery, where a long cut is made to expose the whole of the area to be operated on, or using what is known as a less invasive method, where a number of smaller cuts are made. The less invasive Achilles tendon operation requires more technical skill from the surgeon, but has the advantage that less of the skin is damaged, so it forms a better protective covering over the reconstructed tendon. As the skin at the back of the ankle has a relatively poor blood supply, making smaller cuts can lower the risk of the wound failing to heal and opening up again following surgery.

Where there has been a sudden, clean break in a healthy tendon, Achilles tendon reconstruction involves sewing, or suturing, the separated ends of the tendon back together. If a condition called tendinosis has caused sections of the tendon to deteriorate, tissue grafts may be required. The damaged sections are cut away and the grafts are attached in their place, strengthening the tendon.

Surgical Achilles tendon reconstruction is thought to reduce the risk of future rupturing and to give the best chance of the leg returning to full strength. In comparison, patients whose snapped tendons are treated non-surgically, by wearing a cast while the tendon heals, could take longer to recover and might experience another rupture. Casts or splints are commonly used for a few weeks following surgery, and sports can normally be resumed after around six months.

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