Achilles Tendon Repair

Indications

Achilles Tendon Ruptures, clinical appearance of an achilles tendon rupture
Clinical appearance of an Achilles tendon rupture. Image by Grook Da Oger, Wikimedia Commons, CC BY-SA 3.0.
  • Acute rupture in athletes or high demand patients
  • Delayed presentation with a gap
  • Functional rehabilitation without surgery gives similar outcomes for most (Willits, JBJS 2010. UKSTAR, Lancet 2020)
  • Diagnosis is clinical with the Simmonds calf squeeze test and a palpable gap
  • Ultrasound shows the gap in plantarflexion

Position

  • Prone, both legs prepared to compare resting tension
  • Thigh tourniquet
  • Feet over the end of the table

Operative Steps

  1. Longitudinal posteromedial incision to avoid the sural nerve
  2. Open the paratenon as a separate layer
  3. Krackow or Bunnell core sutures in both ends
  4. Tension the repair to match the resting equinus of the other side
  5. Repair the paratenon
  6. Minimally invasive repair reduces wound problems but risks the sural nerve
  7. Augment chronic ruptures with V-Y advancement, turndown flap or FHL transfer
  8. Close the skin carefully with minimal handling

Postoperative Care

  • Equinus boot with early protected weight bearing
  • Functional rehabilitation over 8 to 12 weeks
  • VTE prophylaxis while immobilised
  • Remove heel wedges progressively
  • Return to running at about 4 to 6 months and sport at 6 to 9 months

Complications

  • Wound breakdown and infection
  • Sural nerve injury
  • Re-rupture and elongation
  • VTE
  • Re-rupture is about 2 to 5% after surgery
  • Adhesions between tendon and skin
  • Weakness of push off

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.