Achilles Tendon Rupture

An Achilles tendon rupture is also called heel cord rupture and is a relatively common sports injury. The Achilles tendon is one of the strongest tendons in the body and it is can withstand a lot of stress.

Certain sports such as football requires a lot of running, starting, stopping and change of direction. This will load the Achilles tendon with a huge amount of force. Depending on the grade of the rupture and where the Achilles tendon is ruptured, surgical treatment may or may not be necessary. However, for a sportsman, it is very common that surgical repair is recommended.

If you imagine at the back of your heel is a very strong elastic band. When this elastic band ruptures, you would like to put it back together to recreate the tension within the band. However, there are many different studies reporting that with conservative treatment i.e. without surgery or by using heel wedges, the result is acceptable.

Looking at the literature, it also suggests that if the patient is treated with conservative management they are likely to go back to pre-injury level and have a higher rate of re-rupture.

In my opinion as a regenerative medicine doctor, as well as orthopaedic surgeon, the goal following this type of injury is to recreate the mechanical strength as well as allowing biological repair. At the end of the day, it is the body that will heal, it is not the sutures that will hold the heel cord in the long run.

Therefore, a hybrid percutaneous technique is very useful in managing high-level athletes for this type of injury. With a percutaneous approach, under the guidance of ultrasound, the Achilles tendon can be approximated together. This will recreate the biomechanical environment for the heel cord as well as preserving the biological environment with a very small chance of infection and will optimise recovery.

This approach has been commonly used in France and has gained great popularity. Although it is never possible to predict a positive outcome 100% of the time, this percutaneous approach makes mechanical as well as biological sense.

Furthermore, tissue glue can be used within the tendon to help stick the tendons together alongside this augmentation repair.

These would be my recommendations. However, there is more one way to treat an injury and a lot depends on the size, the shape and the location of the injury with will result in specifically tailored treatment needed for the individual.

Professor Paul Lee

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