Achilles Tendon Rupture Surgery: Traditional vs. Minimally Invasive Options

Issues Related to Achilles Tendon Rupture Surgery

Hello, doctor.
I would like to ask about my situation.
A few days ago, I fell while sprinting during exercise and was diagnosed with an Achilles tendon rupture at a major hospital.
They did not perform X-rays or an MRI; the diagnosis was made through visual examination and palpation.
I inquired whether there was a minimally invasive surgical option, but the doctor said only traditional surgery was available.
In my anxiousness and lack of experience, I went ahead with the surgery, which was a traditional procedure involving a large incision at the heel for repair, with about 9 to 10 stitches.
Afterward, I researched and found that there are minimally invasive surgical options for Achilles tendon repair, but it was too late for me.
My question is, is the traditional surgery worse than the minimally invasive option? What should I do now that I have not undergone the minimally invasive procedure? I understand it is too late, but I still hope to resolve my doubts and help others who may experience similar injuries in the future.

Lü Chá, 30~39 year old female. Ask Date: 2020/08/03

Dr. Chen Bochen reply Orthopedics

Hello, green tea.
The Achilles tendon is indeed often diagnosed by palpation, so MRI or X-rays are not always necessary.
The advantage of minimally invasive surgery is that it typically results in fewer complications related to the wound, making it more suitable for patients with diabetes or poor liver and kidney function, as these individuals are at a higher risk for wound infections.
The advantage of traditional surgery is that it provides greater repair strength, reducing the likelihood of re-rupture in the future; however, it requires careful wound care to prevent infection.
In conclusion, traditional surgery is not necessarily worse for young people; in fact, it may even be better, so you need not worry.

Reply Date: 2020/08/03

More Info

Achilles tendon rupture is a common injury, particularly among athletes, and the choice of surgical technique can significantly impact recovery and outcomes. The two primary surgical options for repairing an Achilles tendon rupture are traditional open surgery and minimally invasive surgery. Each method has its advantages and disadvantages, and understanding these can help clarify your concerns about the surgery you underwent.

Traditional Open Surgery
In traditional open surgery, a larger incision is made at the back of the heel to access the ruptured tendon directly. This method allows the surgeon to visualize the tendon clearly and perform a direct repair. The advantages of this approach include:
1. Direct Visualization: Surgeons can see the tendon and surrounding structures clearly, which can facilitate a more precise repair.

2. Surgical Control: The larger incision allows for better access to the area, which can be beneficial in complex cases or when there are additional injuries.

However, traditional surgery also has its drawbacks:
1. Increased Recovery Time: The larger incision typically results in a longer recovery period. Patients may experience more pain and swelling post-operatively.

2. Higher Risk of Complications: There is a greater risk of complications such as infection, scarring, and delayed healing due to the larger incision.

3. More Significant Scarring: The visible scar from a larger incision can be a concern for some patients.

Minimally Invasive Surgery
Minimally invasive techniques, such as percutaneous repair, involve smaller incisions and the use of specialized instruments to repair the tendon. The advantages of this approach include:
1. Reduced Recovery Time: Patients often experience less postoperative pain and swelling, leading to a quicker return to normal activities.

2. Lower Risk of Complications: Smaller incisions generally result in a lower risk of infection and other complications.

3. Less Scarring: The cosmetic outcome is typically better with smaller incisions.

However, minimally invasive surgery may have some limitations:
1. Technical Challenges: The surgeon must have specialized training and experience with these techniques, which may not be available at all medical facilities.

2. Limited Visualization: The smaller incisions can make it more challenging to visualize the tendon and surrounding structures, which may affect the repair in complex cases.

Your Situation
Given that you underwent traditional open surgery, it’s understandable to have concerns about whether this was the best option. However, it’s important to note that traditional surgery is still a widely accepted and effective method for repairing Achilles tendon ruptures. Many surgeons prefer this approach, especially in cases where the rupture is complex or when there are other injuries present.

While minimally invasive techniques are gaining popularity and may offer certain advantages, the choice of surgical method often depends on the surgeon's expertise, the specific characteristics of the injury, and the patient's overall health. If your surgeon recommended traditional surgery, it was likely based on their assessment of your specific situation.

Moving Forward
Now that the surgery is completed, focus on your rehabilitation and recovery. Follow your surgeon's post-operative instructions carefully, as rehabilitation is crucial for regaining strength and mobility in the tendon. Physical therapy will likely be an essential part of your recovery process.

In the future, if you or someone else faces a similar injury, it’s beneficial to discuss all available options with the surgeon, including the potential for minimally invasive techniques. Researching and asking questions can help ensure that you make informed decisions about your treatment.

In conclusion, while minimally invasive surgery has its benefits, traditional open surgery remains a valid and effective option for Achilles tendon repair. Your recovery will depend on various factors, including adherence to rehabilitation protocols and the specific nature of your injury.

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