Mini-invasive surgical repair of a ruptured Achilles tendon

The localization of the rupture is identified and demarcated with hatched lines. A short longitudinal incision is made medial to the tendon, about 3 cm proximal to the rupture. The skin is sharply divided. Subcutaneous bleeding is stopped by cauterization. The incision is carried sharply through the fascia and the layer between the fascia and tendon sheath is carefully tunneled. Without injuring the tendon sheath, the dresden instrument is then introduced into the layer between the fascia and tendon sheath, ensuring that the tip of the instrument is correctly positioned, just proximal to the calcaneal insertion.

A needle is pierced through the skin and then through the aperture of the instrument. Correct position of the needle is confirmed by gently pulling the instrument proximally. The second dresden instrument is then introduced into the subfascial layer. The needle is pierced through the tendon and the aperture of the second instrument. And finally through the skin on the opposite side. Correct position of the needle is yet again confirmed by carefully pulling the instruments proximally. A second needle is then introduced using the same procedure. When the dresden instruments are pulled out, the sutures are pulled out together with the instruments.

The instrument to the right has already been removed, and the instrument to the left is just being pulled out. The sutures are anchored by simple interrupted sutures. The tendon is approximated by tightening the knots, and an assistant holds the ankle implant half flexion comparing tension to the non-injured foot. The knots are buried by tying up both sutures and inserting them next to the knots. Finally, the fascia and skin are closed. The plantar flexion angle is now satisfactory, and tendon integrity has been re-established.