Operation of an Achilles tendon tear
As part of the conservative therapy of the Achilles tendon tear, the ultrasound examination and the possibility of conservative therapy in special cases have already been pointed out. However, if you find out during the ultrasound examination of the Achilles tendon tear that the two tendon ends are far apart, it is clear that the tendon ends can no longer grow together on their own. An operation to tear the Achilles tendon must be initiated.
As part of the surgery the skin over the Achilles tendons is cut open. This requires a cut a few cm long (the length can vary).
Torn and dead tendons are removed and the tendon ends are sewn together again. Partly there is a seam through the bone (transosseous) necessary.
After the Achilles tendon rupture operation, the leg to relieve the seam with the help of a lower leg walking cast 30 ° to 40 ° Equinus position immobilized. The patient may then only partially load the leg. After about two weeks, the sutures are removed and a new plaster cast is put on. As a rule, the degree of equinus foot position is reduced (Equinus foot position approx. 10 ° to 20 °). Even now, the leg may only be partially loaded for a further fourteen days. The cast is then removed again and, after checking the healing process, another lower leg walking cast is made. As a rule, a further equinus foot position can now be dispensed with, the patient may then - provided he is pain-free - fully weight the leg again. Another fourteen days after the operation, the cast is removed.After an initial partial load, the load is gradually increased until the patient is able to take full load. This increase in load and in particular the joint mobilization should be included in the subsequent rehabilitation measure (Exercise therapy) are carried out and trained.
In a scientific comparison of the forms of therapy, surgical therapy is ascribed a higher cure rate. However, it should never be forgotten that it is an operation and that the risk of wound infection always plays a role. Newer surgical techniques can sometimes significantly reduce the risk of infection (see prognosis).
Recent studies show in part that, especially in older patients, good results can be achieved even without surgery if the tendon ends are not far away.
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Athletes (joggers, soccer players, etc.) are particularly often affected by the Achilles tendonitis disease. In many cases, the cause of the Achilles tendonitis cannot be identified at first. Therefore, the treatment requires a lot of experience. I focus on Achilles tendonitis.
The aim of every treatment is treatment without surgery with a complete recovery of performance.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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After a Torn Achilles tendon, should be one relatively quickly therapy be initiated. When the decision to operate the tendon has been made, this usually takes place within a week instead, because if the waiting time is too long the Calf muscles shortened and thus shifts the forecast unfavorably. As long as the operation is performed within the first 24 hours, the doctor speaks of a “fresh” Achilles tendon tear: the calf muscles have not yet shortened and the tendon ends are not stiffened. The duration of the operation depends on the individual findings, but also on the applied surgical technique from.
There are generally two surgical techniques that can be used for a ruptured Achilles tendon.
The classic, open surgery, which is carried out by default, usually takes a long time about an hour. In the open Achilles tendon operation, an approx. 10 cm long skin incision is made on the heel. After removing the damaged and torn tendon parts, the surgeon sews the two ends back together (“end-to-end suture”). To do this, he uses a self-dissolving thread.
It is more modern, but also not suitable for all injuries percutaneous or minimally invasive Technology. Just by a single one, about 2 cm. long cut above the torn tendon, the sutures are cut with a special instrument under ultrasound control placed. If you opt for a minimally invasive procedure, you can expect a comparatively short operation time. The open procedure, on the other hand, takes more time.
It is important to have the Achilles tendon given enough time to regenerate, which is why careful follow-up treatment is urgently required. After an operation is a good wound healing essential for the further healing process. For this reason, care should be taken to irritate the surgical site as little as possible in the first few days after the operation. In addition, in the first time anticoagulant drugs how Heparin prescribed, as well as an analgesic medication initiated.
The common procedure after surgery follows the concept of a early functional aftercare. This means that after a short time the foot can be loaded well again. This works with the Put on a special shoewho mostly after three to five days used after the operation. The shoe is mostly for that next six to eight weeks worn, usually after the third or fourth week with a physical therapy is started. During this time, regular checkups should still take place to make sure the tendon is healing well. Light sporting activities can already after 12 weeks to be started. A special insert to relieve the tendon should be worn for at least half a year.
Regardless of the form of therapy for the Achilles tendon tear, a Exercise therapy connect. As part of the conservative therapy, in which the patient was provided with special shoes, the leg is fully resilient again after a short time, so that exercise therapy can be started around three weeks after the tear. According to statistical surveys, you can refrain from wearing the shoes after about eight weeks.
Especially after the operative care of the Achilles tendon tear should be a mobilizing physiotherapy respectively. It can usually be assumed that the patient will be able to exercise exercise on the Achilles tendon again after about three to four months. For active athletes, however, the following applies: training in the sense of competition training should only be carried out again after about half a year of rest. The extent to which you will be able to achieve top performance again varies greatly from person to person.
The Risk of surgery of the Achilles tendon is nowadays very low to assess. Modern Anesthetics as well as a well-rehearsed surgical team can limit the risks of the operation to a minimum.
However, as with any operation, certain risks cannot be ruled out. Since the surgical procedure a Cut through the skin is carried out, the Risk of wound infection.
Kick most often Wound healing disorders which later turns into a heavily pigmented, noticeable one scar be able to show. By correct wound caresuch as regular dressing changes and disinfectant ointments, however, such consequences can easily be avoided. If the wound healing disorder is known, e.g. as part of a Diabetes mellitus, there is the option of preventive antibiotics
In rare cases this can also be due to surgery annoy harmed, especially the purely sensitive Sural nerve. Since it runs right next to the Achilles tendon, it can be overlooked and damaged. If the nerve is accidentally injured, kick Numbness or abnormal sensations in the area of the heel and the side of the foots on. However, experienced surgeons can usually localize it well.
Dreaded, if rare, is one repeated rupture of the Achilles tendon after the operation. The doctor then speaks of a "rerupture". Statistically, this comes in after an operation, depending on the study 1-4% of cases and thus does better than conservative therapy without surgery.
In addition, there is a risk of having surgery considerable loss of strength and a Reduced mobility may occur. It is important to prevent this through careful aftercare and consistent treatment through physiotherapy. At Competitive athletes however, there is no guarantee that post-operative performance will return to what it was before.
Usually the procedure can be performed under local anesthesia (Local anesthesia) so that possible risks of a general anesthetic excluded are.
The prognosis after Achilles tendon surgery is generally very good. The earlier treatment is given, the more likely a full recovery is. Through intensive physical therapy the load capacity can in most cases be within 12-18 months nearly restored. Of course, the prognosis can vary in individual cases. However, if those affected have enough patience and motivation, the chances are extremely good.