Achilles Tendon Reconstruction (Chronic Rupture / Re-Rupture)

⚙️What This Procedure Involves

An incision is made along the back of the calf and ankle. The scarred, retracted tendon ends are identified. Depending on the gap size, reconstruction may involve V-Y tendon advancement (lengthening the proximal tendon by cutting it in a V and closing it as a Y), turndown flap (a strip of proximal tendon is turned down to bridge the gap), FHL (flexor hallucis longus) tendon transfer (a nearby tendon is rerouted to augment the repair), or allograft augmentation. The operation takes one and a half to two hours.

💡Why It May Be Recommended

Reconstruction is needed when a chronic Achilles rupture (typically more than four weeks old) has retracted, creating a gap that cannot be bridged with direct repair. Also for re-ruptures after failed primary repair.

⚖️Non-Operative Alternatives

For elderly or sedentary patients, acceptance of the chronic rupture with AFO bracing and calf strengthening may provide adequate function. This avoids the risks of complex reconstruction.

📋Preparing for Surgery

MRI to assess the gap size and tendon quality. Assessment of the FHL tendon if transfer is planned.

✅Expected Benefits

Restoration of Achilles tendon continuity and push-off strength. Most patients achieve functional improvement, though strength is typically 70–80% of normal.

⚠️Common Risks

• Wound healingCommon

  The posterior calf skin is vulnerable, particularly in chronic cases with poor tissue quality.

• Reduced push-off strengthExpected

  Strength rarely returns to full normal.

• Prolonged recoveryExpected

  Six to twelve months.

• Sural nerve irritationCommon

  Numbness on the outer foot.

🔴Less Common but Serious Risks

• Re-ruptureUncommon

  The reconstruction may fail.

• Wound breakdownUncommon

  Particularly in smokers, diabetics, and previously operated tissue.

• Deep infectionUncommon

  Around the repair or allograft.

• FHL weaknessCommon

  If FHL transfer is performed, big toe flexion is weakened.

• Blood clotsUncommon

  DVT during immobilisation.

💉Anaesthetic Considerations

General or spinal anaesthesia with nerve block. Prone position.

🏃Recovery and Rehabilitation

Non-weight-bearing in a cast for six to eight weeks. Gradual transition to weight-bearing in a boot with heel raises. Progressive heel raise reduction over four weeks. Physiotherapy for calf strengthening from eight weeks. Return to light sport at six months. Full recovery nine to twelve months.

📅Follow-Up

Wound check at two weeks. Reviews at six weeks, three months, and six months.

❓Frequently Asked Questions