Achilles Tendon Rupture: Surgical Options and Recovery for Athletes

Achilles tendon

Dear Director Chen,
Last May, I ruptured my Achilles tendon while playing softball.
Although I sought medical assistance, I naively believed that I could heal through rehabilitation.
For over a year, I have been seeing a rehabilitation specialist, and whenever I felt slightly better, I would return to playing softball (though I was cautious not to run fast).
Unfortunately, in May of this year, I re-ruptured the tendon while running the bases.
After an evaluation by an orthopedic surgeon, I was advised that surgical intervention for repair is necessary.
Considering my desire to continue exercising post-surgery, I consulted two different hospitals, and the doctors provided differing treatment approaches.
Since my initial rupture occurred outside the optimal treatment window, the current rupture (approximately 4 cm) raises concerns.
The doctors do not guarantee that traditional surgical repair using the existing Achilles tendon will be effective and mentioned the possibility of harvesting ligaments from other areas for repair.
One doctor suggested harvesting a ligament from the big toe, while another recommended taking a ligament from the inner thigh.

I would like to ask you, if harvesting a ligament is necessary for the repair, which location would typically have the least impact on daily life and still allow for a full recovery to engage in recreational activities afterward? I would greatly appreciate your guidance on this matter.

Liu Danni, 50~59 year old female. Ask Date: 2022/06/30

Dr. Chen Bochen reply Orthopedics

Hello, chronic injuries of the Achilles tendon often require autograft ligaments for repair.
Most surgeons prefer to harvest ligaments from the inner thigh, as this approach generally has a smaller impact on daily life.

Reply Date: 2022/06/30

More Info

Achilles tendon ruptures are a common injury among athletes, particularly those involved in sports that require sudden acceleration, deceleration, and jumping, such as baseball, basketball, and tennis. The Achilles tendon connects the calf muscles to the heel bone and is crucial for activities that involve pushing off the foot. When it ruptures, it can significantly impact an athlete's ability to perform.

In your case, it appears that you initially attempted to manage the injury conservatively through rehabilitation, which is often a viable option for partial ruptures or less severe injuries. However, complete ruptures typically require surgical intervention for optimal recovery, especially for athletes who wish to return to high-level sports. The fact that you experienced a second rupture after attempting to return to play suggests that the initial conservative management may not have been sufficient for your specific injury.

Regarding surgical options, there are generally two main approaches to repairing an Achilles tendon rupture: open surgery and minimally invasive surgery. Open surgery involves making a larger incision to directly visualize and repair the tendon, while minimally invasive techniques use smaller incisions and specialized instruments. Both methods aim to reattach the torn ends of the tendon and restore its function.

Given that you have already passed the critical window for optimal healing (the "golden period"), the surgical approach may need to be more aggressive. The suggestion to use grafts from other tendons (such as from the big toe or the inner thigh) is not uncommon in cases where the tendon ends are too far apart to be sutured directly. The choice of graft site can depend on several factors, including the surgeon's preference, the availability of tissue, and the potential impact on your daily activities and athletic performance.

1. Graft Options:
- Flexor Hallucis Longus (FHL) Graft: This tendon is located near the big toe and is often used because it can be harvested with minimal impact on foot function. However, it may affect the ability to flex the big toe fully.

- Gracilis or Semitendinosus Graft: These tendons are taken from the inner thigh and can provide a robust option for reconstruction. They are less likely to affect daily activities but may impact certain movements in sports.

2. Post-Surgical Rehabilitation: Regardless of the graft used, rehabilitation will be crucial for recovery. A structured rehabilitation program typically includes:
- Initial Phase: Focus on reducing swelling and pain, followed by gentle range-of-motion exercises.

- Strengthening Phase: Gradually introducing weight-bearing activities and strengthening exercises for the calf and surrounding muscles.

- Functional Phase: Incorporating sport-specific drills and agility training as healing progresses.

3. Long-Term Outlook: The success of the surgery and rehabilitation will largely depend on adherence to the rehabilitation protocol and the body's response to the graft. Many athletes can return to their pre-injury level of activity, but this can take several months to a year, depending on the severity of the injury and the surgical technique used.

In conclusion, if surgical intervention is necessary, the choice of graft should be made in consultation with your orthopedic surgeon, considering both the functional outcomes and your lifestyle needs. It is essential to follow a comprehensive rehabilitation program post-surgery to maximize your chances of returning to sports safely. Always communicate openly with your healthcare providers about your goals and concerns to ensure the best possible outcome.

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