Surgical Repair of a Ruptured Achilles

 

When I got home from the ice rink I called a friend of mine who was the other foot and ankle surgeon at The Ohio State University and told him I had ruptured my Achilles.  He had been treating me for some time now and wasn’t surprised.  We had an MRI from a month ago showing tendonitis, tendonosis and paratendonitis; all conditions I’ll talk about later.  He called the hospital and scheduled me for surgery the next morning.

One of the advantages of being a surgeon is that we get to watch other surgeons operate.  It’s not uncommon for a surgeon who is waiting between his own cases to walk into another operating room and visit with the person operating in that room.  We all trained in different places, so our techniques differ slightly and by watching another surgeon you may pick up a nuance you haven’t seen before.  You also make a subconscious note about who you would want to operate on you should you develop a condition requiring surgical intervention.  Since I would be face down and unconscious during my own operation, I wouldn’t be able to tell this surgeon what to do during the case.  I had to be sure he knew what he was doing.

I think it’s important to get a ruptured Achilles repaired as soon as possible.  This is no time for denial if you think your Achilles is ruptured.  If there is a rupture, the Gastroc-Soleus, or calf muscles begin to contract and the gap between the two ends increases.  I have been involved with cases where the patient delayed and I couldn’t get the two ends of the Achilles back together.  In this instance another tendon has to be harvested for a graft and the repair may not be as strong and as a result re-rupture under tension.  Plus, the repair just doesn’t look as good to the experienced surgeon.  There is something about esthetics in a surgical procedure that’s hard to explain to the non-surgeon.  If the surgery doesn’t look good, it probably isn’t.

Before the procedure, my surgeon and I agreed to use my own platelet rich plasma (PRP) within the repair sight.  There is some disagreement concerning the efficacy of PRP, but the platelets do contain growth factors and cytokines that stimulate healing.  I had been using growth factors for a long time to help heal diabetic ulcers and believe they truly increase wound healing, not only by speeding the process, but also by improving the quality of the tissue that grows.

Oddly enough, I had played hockey the day before with my anesthesiologist.  Maybe it wasn’t that odd since I called him and asked him to put me to sleep.  We were talking in the pre-operative holding area when he injected Versed into my IV.  That really is the last thing I remember until the post anesthesia care unit or PACU.  The anesthesiologist put in a nerve block so my lower leg was numb and would be for the day.  I couldn’t put any weight on the operated leg for fear I would re-tear the repaired Achilles and we would be back to step one.  This required crutch training or a refresher course before I left the hospital.  I had used crutches a few times in college due to some knee and leg injuries, so it didn’t take long to become proficient.

I had a prescription for pain pills, a machine that circulated ice water around the wound to decrease post-op swelling and instructions to keep my leg elevated higher than my broken heart.  Besides a good solid repair of a ruptured Achilles by a great surgeon, I now had a lot of time to think about athletic injuries, Achilles injuries in particular, their prevention and rehabilitation.  Sometimes that post-op pain medication tends to make one wax philosophical.